Competing Risk Bias in Prognostic Models Predicting Hepatocellular Carcinoma Occurrence: Impact on Clinical Decision-making


Innes, Hamish ORCID: 0000-0003-0565-1083, Johnson, Philip ORCID: 0000-0003-1404-0209, McDonald, Scott A, Hamill, Victoria, Yeung, Alan, Dillon, John F, Hayes, Peter C, Went, April, Barclay, Stephen T, Fraser, Andrew et al (show 3 more authors) (2022) Competing Risk Bias in Prognostic Models Predicting Hepatocellular Carcinoma Occurrence: Impact on Clinical Decision-making. Gastro Hep Advances, 1 (2). pp. 129-136.

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Abstract

Background and Aims: Existing models predicting hepatocellular carcinoma (HCC) occurrence do not account for competing risk events and, thus, may overestimate the probability of HCC. Our goal was to quantify this bias for patients with cirrhosis and cured hepatitis C. Methods: We analyzed a nationwide cohort of patients with cirrhosis and cured hepatitis C infection from Scotland. Two HCC prognostic models were developed: (1) a Cox regression model ignoring competing risk events and (2) a Fine-Gray regression model accounting for non-HCC mortality as a competing risk. Both models included the same set of prognostic factors used by previously developed HCC prognostic models. Two predictions were calculated for each patient: first, the 3-year probability of HCC predicted by model 1 and second, the 3-year probability of HCC predicted by model 2. Results: The study population comprised 1629 patients with cirrhosis and cured HCV, followed for 3.8 years on average. A total of 82 incident HCC events and 159 competing risk events (ie, non-HCC deaths) were observed. The mean predicted 3-year probability of HCC was 3.37% for model 1 (Cox) and 3.24% for model 2 (Fine-Gray). For most patients (76%), the difference in the 3-year probability of HCC predicted by model 1 and model 2 was minimal (ie, within 0 to ±0.3%). A total of 2.6% of patients had a large discrepancy exceeding 2%; however, these were all patients with a 3-year probability exceeding >5% in both models. Conclusion: Prognostic models that ignore competing risks do overestimate the future probability of developing HCC. However, the degree of overestimation—and the way it is patterned—means that the impact on HCC screening decisions is likely to be modest.

Item Type: Article
Uncontrolled Keywords: Patient Safety, Chronic Liver Disease and Cirrhosis, Liver Cancer, Digestive Diseases, Rare Diseases, Hepatitis - C, Liver Disease, Hepatitis, Cancer, Emerging Infectious Diseases, Infectious Diseases, 3 Good Health and Well Being
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 21 Mar 2024 15:01
Last Modified: 21 Mar 2024 15:01
DOI: 10.1016/j.gastha.2021.11.008
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3179707
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