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Current trends in the risk prediction for hepatitis B virus-related hepatocellular carcinoma

Ken Liu
Ken Liu
 and 
Grace Lai-Hung Wong
Grace Lai-Hung Wong
   | Jan 31, 2017
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Article Category: Mini review article
Published Online: Jan 31, 2017
Page range: 3 - 13
DOI: https://doi.org/10.5372/1905-7415.1001.459
Keywords
© 2016 Ken Liu, Grace Lai-Hung Wong, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Recommendations on HCC surveillance in HBV patients by liver associations

APASL [25] AASLD [26] EASL-EORTC [27]
Population group

Cirrhosis

Cirrhosis

Males age >40

Female age >50

Family history of HCC

African/North American blacks

Cirrhosis

HBV carrier with active hepatitis

Family history of HCC

Modality US + AFP US US
Interval 6-monthly 6-monthly 6-monthly

Risk factors for HBV-related HCC

GAG-HCC [52] CU-HCC [53] REACH-B [54] PAGE-B [55]
Patients (n) 820 1,005 3,584 1,325
Training cohort (TC) Chinese Chinese Chinese Europeans
Patients (n) Leave one out cross validation 424 1505 490
Validation cohort (VC) Chinese Chinese and Koreans Italians
Age (years) 40.6 48.0 45.7 52
Antiviral therapy (%) 0 TC: 15.1 TC: 0 TC: 100
VC: 25 VC: 0 VC: 100
Cirrhosis (%) 15.1 TC: 38.1 TC: 0.0 TC: 20.3
VC: 16.3 VC: 18.4 VC: 47.8
Follow-up (years) 6.4 9.9 12.0 4.2
HCC (n, %) 40(4.9) TC: 105 (10.4) TC: 131 (3.7) TC: 51 (3.8)
VC: 45 (10.6) VC: 111(7.4) VC: 34 (6.9)
Score Variable Points Variable Points Variable Points Variable Points
Age 1 per year Age >50 years 3 Age 1 per 5 years Age 16–29 0
Male 16(14

Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL.

)		 Albumin ≤3.5g/dL 20 over 30 30–39 2
Cirrhosis 30(33

Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL.

)		 Bilirubin > 1. lmg/dL 1.5 Male 2 40–49 4
HBVDNA 3 (3

Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL.

) per log		 Cirrhosis 15 ALT (U/L) 15–44 1 50–59 6
BCP Mutation 19 HBVDNA ≥45 2 60–69 8
4–6 log 1 HBeAg positive 2 ≥70 10
6 log 4 HBVDNA Male 6
<41og 0 Platelets (/mm3)
4–<5 log 3 ≥200,000 0
5–<6 log 5 100,000-199,999 6
≥6 log 4 <100,000 9
Optimum cut-offs With inclusion of BCP Mutation: Low risk <5 17-point risk score Low risk <10
Intermediate risk 5–20 Intermediate 10–17
Lowrisk<101 High risk >20 High risk ≥18
High risk ≥ 101
Without inclusion of BCP mutation:
5-year prediction
Low risk < 100
High risk ≥ 101
10-year prediction
Low risk <82
High risk ≥82
Performance Using a cut-off of 101: Using a cut-off of 5: AUROC: Using cut-off of 10:
5-year prediction 5-year prediction 3 years 0.811 Harrell’s c-index 0.82
AUROC0.88 AUROC 0.76 5 years 0.796 5-year prediction
Sensitivity 87.9% Sensitivity 78.3% 10 years 0.769 Sensitivity 100%
Specificity 76.2% Specificity 72.8% Specificity 19.6%
PPV 14.6% PPV 14.2% PPV 10.3%
NPV 99.3% NPV 98.3% NPV 100%
10-year prediction 10-year prediction
AUROC 0.89 AUROC 0.78
Sensitivity 100% Sensitivity 81.0%
Specificity 79.1% Specificity 75.7%
PPV 25.7% PPV 26.8%
NPV 100% NPV 97.3%
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