Fan, Rong, Papatheodoridis, George, Sun, Jian, Innes, Hamish, Toyoda, Hidenori, Xie, Qing, Mo, Shuyuan, Sypsa, Vana, Guha, Indra Neil, Kumada, Takashi et al (show 32 more authors)
(2020)
aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis.
JOURNAL OF HEPATOLOGY, 73 (6).
pp. 1368-1378.
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Jinlin Surveillnace paper all.docx - Author Accepted Manuscript Download (7MB) |
Abstract
<h4>Background & aims</h4>Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis.<h4>Methods</h4>A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686).<h4>Results</h4>We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin-bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%.<h4>Conclusions</h4>This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide.<h4>Lay summary</h4>In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin-bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.
Item Type: | Article |
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Uncontrolled Keywords: | HCC, Risk score, Hepatitis B virus, Hepatitis C virus, Non-alcoholic fatty liver disease |
Depositing User: | Symplectic Admin |
Date Deposited: | 29 Jul 2020 13:18 |
Last Modified: | 18 Jan 2023 23:39 |
DOI: | 10.1016/j.jhep.2020.07.025 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3095691 |