Toronto HCC risk index: A validated scoring system to predict 10-year risk of HCC in patients with cirrhosis

Sharma, Suraj; Kowgier, Matthew; Hansen, Bettina E.; Brouwer, Willem Pieter; Maan, Raoel; Wong, David; Shah, Hemant; Khalili, Korosh; Yim, Colina; Heathcote, E. Jenny; Janssen, Harry L.A.; Sherman, Morris; Hirschfield, Gideon M.; Feld, Jordan J.

doi:10.1016/j.jhep.2017.07.033

Cited by 139 publications

(169 citation statements)

References 34 publications

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“…Our results also suggest that AFP can be a powerful predictor of HCC when used in combination with other risk factors, even if it is not adequate as a sole screening test. Investigators have recently attempted to develop algorithm-based risk models to estimate HCC risk and target high-risk patient populations for screening[ 26 , 27 , 35 , 50 ]. Many of these models include AFP and other variables described in this study, and have shown early promise, though they have yet to be validated in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

et al. 2018

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Background and aimsHepatocellular carcinoma (HCC) risk is high in cirrhosis. We sought to describe differences in HCC risk, predictors and trends over time according to etiology of cirrhosis.MethodsWe identified 116,404 patients with cirrhosis diagnosed between 2001–2014 in the VA healthcare system and determined incident HCC cases occurring from the date of cirrhosis diagnosis until 01/31/2017. Patients were divided by cirrhosis etiology into hepatitis C virus (HCV, n = 52,671), alcoholic liver disease (ALD, n = 35,730), nonalcoholic fatty liver disease (NAFLD, n = 17,354), or OTHER (n = 10,649).ResultsDuring a mean follow-up of 4.3 years, 10,042 new HCC cases were diagnosed. Patients with HCV had >3 times higher incidence of HCC (3.3 per 100 patient-years) than patients with ALD (0.86/100 patient-years), NAFLD (0.90/100 patient-years) or OTHER (1.0/100 patient-years), an association that persisted after adjusting for baseline characteristics. HCC incidence was 1.6 times higher in patients with cirrhosis diagnosed in 2008–2014 (2.47/100 patient-years) than in 2001–2007 (1.55/100 patient-years).Independent predictors of HCC among all cirrhosis etiologies included: age, male sex, Hispanic ethnicity, high serum alpha fetoprotein, alkaline phosphatase and AST/√ALT ratio and low serum albumin and platelet count. Diabetes was associated with HCC in ALD-cirrhosis and NAFLD-cirrhosis, and BMI in ALD-cirrhosis.ConclusionsHCC risk is 3 times greater in cirrhotic patients with HCV than ALD or NAFLD. HCC risk continues to increase over time in analyses extending to 2017 in cirrhosis of all etiologies. Multiple readily available risk factors for HCC were identified that were influenced by cirrhosis etiology and could be used to develop HCC risk estimation models.

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Section: Discussionmentioning

confidence: 99%

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

et al. 2018

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“…33 In the large validation cohort included in the CAMD score study, the 3-/5year HCC predictability of PAGE-B was similar to that of CAMD score. 28 Finally, in the validation cohort of mPAGE-B study, the researchers also assessed the predictability of PAGE-B, CU-HCC, GAG-HCC and REACH-B as well as of the Toronto HCC risk index (THRI) score, 40 which was originally introduced to predict HCC development in patients with cirrhosis regardless of aetiology.…”

Section: Independent Validati On Of H CC Ris K Score S In a S Ian Pmentioning

confidence: 99%

Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B

Voulgaris

Papatheodoridi

Lampertico

et al. 2020

Liver International

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Background Several risk scores have been recently developed to predict hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. We systematically assessed the performance of the available HCC risk scores. Methods Literature search was performed to identify all published studies reporting development or external validation of HCC risk scores in CHB patients. Results Until March 2019, 12 scores were developed in untreated Asian and 7 scores in treated Asian (n = 6) or Caucasian (n = 1) patients. All scores provided significant predictions for HCC development in the derivation and validation cohorts of their original studies (c‐statistic: 0.76‐0.95) and usually classified patients into low, medium and high HCC risk groups. Eleven independent studies and three studies developing their own scores have validated externally some scores in Asian (GAG‐HCC:5, CU‐HCC:6, REACH‐B:6, REACH‐Bm:4, LSM‐HCC:3, PAGE‐B:5) or Caucasian/mixed origin patients (GAG‐HCC:4, CU‐HCC:4, REACH‐B:4, PAGE‐B:2). All scores offered acceptable predictability in almost all independent Asian cohorts (c‐statistic: 0.70‐0.86), but only PAGE‐B and recently modified PAGE‐B (mPAGE‐B) offered good predictability in all independent Caucasian and/or Asian cohorts. Negative predictive values for 5‐year HCC prediction were ≤99% (95%‐99%) in most independent cohorts assessing Asian risk scores and 99%‐100% in all independent cohorts (Caucasian/mixed origin:2; Asian:3) assessing PAGE‐B and/or recently mPAGE‐B. Conclusions Direct comparison of the newest HCC risk scores in independent patient cohorts of different origin remains intriguing, although statistical associations may not be directly transferable to clinical practice. PAGE‐B and recently mPAGE‐B score seem to offer persistently high predictability for Caucasian and/or Asian treated patients with low HCC risk who require no surveillance.

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“…Our RNN models exhibited an AUROC of 0.759 among all samples and 0.806 among samples from patients with SVR, which is considered very good and compares favorably with other HCC risk prediction models. 6 , 45 , 46 Equally importantly, our models had great calibration and excellent agreement between observed and predicted HCC risk ( Table 3 ).…”

Section: Discussionmentioning

confidence: 70%

Assessment of a Deep Learning Model to Predict Hepatocellular Carcinoma in Patients With Hepatitis C Cirrhosis

et al. 2020

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Key Points Question Can deep learning recurrent neural network (RNN) models using raw longitudinal data extracted directly from electronic health records outperform conventional regression models in predicting the risk of developing hepatocellular carcinoma (HCC)? Findings This prognostic study included 48 151 patients with hepatitis C virus (HCV)–related cirrhosis in the national Veterans Health Administration who had at least 3 years of follow-up after the diagnosis of cirrhosis. Deep learning RNN models outperformed conventional linear regression models and could be used to identify patients with HCV-related cirrhosis at high risk of developing HCC. Meaning The findings of this study suggest that RNN models could have multiple applications in clinical practice and could be applied to HCC outreach and surveillance strategies.

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Toronto HCC risk index: A validated scoring system to predict 10-year risk of HCC in patients with cirrhosis

Cited by 139 publications

References 34 publications

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B

Assessment of a Deep Learning Model to Predict Hepatocellular Carcinoma in Patients With Hepatitis C Cirrhosis

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