Abstract
Many HCC risk prediction scores were developed to guide HCC risk stratification and identify CHC patients who either need intensified surveillance or may not require screening. There is a need to compare different scores and their predictive performance in clinical practice. We aim to compare the newest HCC risk scores evaluating their discriminative ability, and clinical utility in a large cohort of CHC patients. The performance of the scores was evaluated in 3075 CHC patients who achieved SVR following DAAs using Log rank, Harrell's c statistic, also tested for HCC-risk stratification and negative predictive values. HCC developed in 212 patients within 5years follow-up. Twelve HCC risk scores were identified and displayed significant Log rank (p ≤ 0.05) except Alonso-Lopez TE-HCC, and Chun scores (p = 0.374, p = 0.053, respectively). Analysis of the remaining ten scores revealed that ADRES, GES pre-post treatment, GES algorithm and Watanabe (post-treatment) scores including dynamics of AFP, were clinically applicable and demonstrated good statistical performance; Log rank analysis < 0.001, Harrell's C statistic (0.66-0.83) and high negative predictive values (94.38-97.65%). In these three scores, the 5years cumulative IR in low risk groups be very low (0.54-1.6), so screening could be avoided safely in these patients. ADRES, GES (pre- and post-treatment), GES algorithm and Watanabe (post-treatment) scores seem to offer acceptable HCC-risk predictability and clinical utility in CHC patients. The dynamics of AFP as a component of these scores may explain their high performance when compared to other scores.
Highlights
Chronic hepatitis C infection is a major public health problem with an estimated 71 million persons chronically infected with hepatitis C worldwide [1]
The performance of the scores was evaluated in 3075 CHC patients who achieved sustained virologic response (SVR) following direct acting antivirals (DAAs) using Log rank, Harrell’s c statistic, tested for hepatocellular carcinoma (HCC)-risk stratification and negative predictive values
Millions of patients with Hepatitis C virus (HCV) infection are expected be treated over the decade. viral clearance after DAAs lowered but did not completely end the occurrence of HCC in post-SVR patients [3,4,5,6]
Summary
Chronic hepatitis C infection is a major public health problem with an estimated 71 million persons chronically infected with hepatitis C worldwide [1]. An annual incidence of 1.5% or higher would permit surveillance of HCC [9] This conclusion was backed up by data indicating curative treatment, improved survival and a higher rate of early diagnosis among patients undergoing screening for HCC [10]. ‘one-size-fits-all’ strategy increases the health care costs in low- to middle-income countries, with a high HCV prevalence, it is estimated that a small percentage of patients with cirrhosis are monitored according to guidelines, highlighting the unmet need for an optimal simple score for individualized HCC surveillance [11]. Many HCC risk prediction scores were developed to guide HCC risk stratification and identify CHC patients who either need intensified surveillance or may not require screening. We aim to compare the newest HCC risk scores evaluating their discriminative ability, and clinical utility in a large cohort of CHC patients
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