Performance of models to predict hepatocellular carcinoma risk among UK patients with cirrhosis and cured HCV infection

Innes, Hamish; Jepsen, Peter; McDonald, Scott; Dillon, John; Hamill, Victoria; Yeung, Alan; Benselin, Jennifer; Went, April; Fraser, Andrew; Bathgate, Andrew; Ansari, Azim; Barclay, Stephen T.; Goldberg, David J.; Hayes, Peter; Johnson, Philip J.; Barnes, Eleanor; Irving, William L.; Hutchinson, Sharon; Guha, Indra Neil

doi:10.1016/j.jhepr.2021.100384

Cited by 18 publications

(19 citation statements)

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“…Our conclusions concerning the model performance after SVR should be treated with caution since a considerable period of time may have elapsed between recording the aMAP score on study entry, and achievement of SVR. However, we have recently confirmed the good performance of aMAP in a large series of HCV-cured patients from the UK [20]. Appropriate HCC screening strategies for patients with cirrhosis who have been cured of HCV by the use of DAAs is currently a major clinical concern [21][22][23][24][25] as recently reviewed by Maan et al [26].…”

Section: Discussionsupporting

confidence: 61%

“…Although the aMAP score has been validated in the original [12], and subsequent publications [18,19], and shown to be the bestperforming of current HCC prediction models [20], its role has not yet been established in the prospective setting. Strictly speaking the approach adopted here is to test the aMAP algorithm for risk stratification in patients with chronic hepatitis but it cannot claim to be a prospective study insomuch as it was not undertaken explicitly to test aMAP performance in routine clinical surveillance practice.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

et al. 2022

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Background and aims The aMAP score is a model that predicts risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis. Its performance in a ‘real world’ surveillance setting has not yet been ascertained. Patients and methods We had access to a cohort of 3473 individuals enrolled in a rigorously implemented and prospectively accrued surveillance programme (patients undergoing regular ultrasound and biomarker examination between 1998 and 2021). During this period 445 had HCC detected. Of these, 77.8% had early stage disease (within Milan criteria), permitting potentially curative therapy to be implemented in nearly 70% of cases. We applied the recently developed aMAP score to classify patients according to their initial aMAP score in to low, medium and high-risk groups as proposed in the original publication. The performance of the aMAP score was assessed according to the concordance-index and calibration (i.e. agreement between observed and predicted risk). Allowance was made for competing causes of death. Results The aMAP score achieved an overall C-index of 0.81 (95% CI: 0.79–0.82) consistent with the initial report and was unaffected by allowance for competing causes of death. Sub-group analysis showed that the results did not change significantly according to gender, or aetiology. However, aMAP discrimination was greater for younger individuals (versus older individuals), and also for individuals without cirrhosis. The HCC incidence rate was 0.98, 7.05 and 29.1 events per 1000 person-years in the low-, moderate- and high-risk aMAP groups, respectively. Conclusions The results from this ‘real-world’ cohort demonstrate that risk stratification is a realistic prospect and that identification of a subgroup of chronic liver disease patients who have a very low risk of HCC is feasible.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

et al. 2022

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“…A recent study constructed a model based on albumin-bilirubin score, platelet count, and the presence of diabetes mellitus, to predict the risk of HCC occurrence after HCV eradication [59]. Similarly, Innes et al identified a predictive model based on age, male sex, albuminbilirubin score and platelet count as the best-performing model to predict HCC risk among cirrhotic patients after HCV treatment [60]. Another study, from Tani et al, used a simple scoring system based on age of HCV patients and AFP level after DAA treatment to select patients with a high risk of HCC development [61].…”

Section: Predictive Models and Scoresmentioning

confidence: 99%

Predictive Factors for Hepatocellular Carcinoma Development after Direct-Acting Antiviral Treatment of HCV

Jilkova

Saleem

Afzal

et al. 2021

Livers

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Chronic hepatitis C virus infection is still one of the major risk factors for the development of hepatocellular carcinoma (HCC), the most frequent type of primary liver cancer. Direct-acting antivirals have substantially improved the cure rate of the virus, but the risk of hepatitis C virus-related HCC remains high, mainly in patients with advanced liver fibrosis and cirrhosis. HCC is often asymptomatic and, therefore, remains undetected until the late tumor stage, which is associated with poor survival rates. Therefore, to improve the surveillance programs following HCV eradication, there is a need to summarize predictive factors or potential biomarkers, to specifically identify patients likely to develop HCC after direct-acting antiviral treatment. This review outlines the most recent data about different predictive factors for HCC development after direct-acting antiviral treatment of hepatitis C virus-infected patients, to improve the clinical management of patients with chronic hepatitis C virus.

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“…Prognostic models are now available that can estimate a cirrhosis patient's future probability of HCC occurrence (13)(14)(15)(16). Some of these models have been externally validated in independent data sets (13,17), which is the acid test of a model's performance and a prerequisite for clinical use (18). In theory, this presents an opportunity to tailor clinical management to a patient's specific risk profile.…”

Section: Introductionmentioning

confidence: 99%

Comparing Predicted Probability of Hepatocellular Carcinoma in Patients With Cirrhosis With the General Population: An Opportunity to Improve Risk Communication?

et al. 2022

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INTRODUCTION:Risk scores estimating a patient's probability of a hepatocellular carcinoma (HCC) diagnosis are abundant but are difficult to interpret in isolation. We compared the predicted HCC probability for individuals with cirrhosis and cured hepatitis C with the general population (GP).METHODS:All patients with cirrhosis achieving sustained viral response (SVR) in Scotland by April 2018 were included (N = 1,803). The predicted 3-year probability of HCC at time of SVR achievement was determined using the aMAP prognostic model. GP data on the total number of incident HCCs in Scotland, stratified by demographics, were obtained from Public Health Scotland. Predicted HCC risk of cirrhosis SVR patients was compared with GP incidence using 2 metrics: (i) incidence ratio: i.e., 3-year predicted probability for a given patient divided by the 3-year probability in GP for the equivalent demographic group and (ii) absolute risk difference: the 3-year predicted probability minus the 3-year probability in the GP.RESULTS:The mean predicted 3-year HCC probability among cirrhosis SVR patients was 3.64% (range: 0.012%–36.12%). Conversely, the 3-year HCC probability in the GP was much lower, ranging from <0.0001% to 0.25% depending on demographics. The mean incidence ratio was 410, ranging from 5 to >10,000. The mean absolute risk difference was 3.61%, ranging from 0.012% to 35.9%. An online HCC-GP comparison calculator for use by patients/clinicians is available at https://thrive-svr.shinyapps.io/RShiny/.DISCUSSION:Comparing a patient's predicted HCC probability with the GP is feasible and may help clinicians communicate risk information and encourage screening uptake.

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Performance of models to predict hepatocellular carcinoma risk among UK patients with cirrhosis and cured HCV infection

Abstract: Performance of models to predict hepatocellular carcinoma risk among UK patients with cirrhosis and cured hepatitis C infection.

Cited by 18 publications

References 40 publications

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify

Predictive Factors for Hepatocellular Carcinoma Development after Direct-Acting Antiviral Treatment of HCV

Comparing Predicted Probability of Hepatocellular Carcinoma in Patients With Cirrhosis With the General Population: An Opportunity to Improve Risk Communication?

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