Abstract
BackgroundThe Toronto hepatocellular carcinoma (HCC) risk index (THRI) was developed to predict HCC in patients with cirrhosis. This study aimed to validate the THRI in a 10-year Asian cohort.MethodsA total of 2836 patients with cirrhosis at the First Affiliated Hospital of Soochow University between January 2008 and May 2018 were evaluated. Based on the THRI value at diagnosis, patients were divided into three groups (< 120, low-risk; 120–240, intermediate-risk; > 240, high-risk). Student’s t test and Fisher’s exact test were applied to compare parameters between the HCC group and the non-HCC group. The receiver operator characteristic (ROC) curve was drafted to identify the value of the THRI in predicting HCC. Logistic regression was utilized to assess the relationship between the development of HCC and THRI values. The incidence of HCC was calculated for the three groups using the Kaplan-Meier method, and curves were compared using the log-rank test.ResultsOf 520 patients enrolled in this study, 76 patients developed HCC. Patients who developed HCC had a higher THRI score than those who did not develop HCC (279.5 ± 57.1 vs. 232.3 ± 67.6, respectively, p < 0.001). The area under the ROC curve for the THRI to predict HCC was 0.707 ([95% CI 0.645–0.769], p < 0.001), with a sensitivity of 0.842 and a specificity of 0.486 when the cutoff THRI value was 226. Compared to the low-risk group, the high-risk group presented higher odds of developing HCC (adjusting odds ratio 1.026 [95% CI 1.002–1.051], p = 0.036). Differences existed in the cumulative incidence of HCC among the three risk groups (log-rank, p < 0.001). The 5-year cumulative HCC incidence of the low-risk group, intermediate-risk group, and high-risk group was 0%, 13%, and 34%, respectively.ConclusionThis study validated THRI values for predicting HCC in Asians with cirrhosis, which presented a fine sensitivity to identify the high-risk population of HCC for secondary prevention.
Highlights
The Toronto hepatocellular carcinoma (HCC) risk index (THRI) was developed to predict HCC in patients with cirrhosis
Several scoring systems and models were developed to predict the risk of HCC, including the Chinese University of Hong Kong (CUHK) clinical scoring system [15]; the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/ Cancer-Hepatitis B Virus (REVEAL-HBV) nomograms [16]; the Guide with Age, Gender, HBV DNA, Core Promoter Mutations and Cirrhosis (GAG-HCC) risk score [17]; the Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B) [18]; the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) model [19]; and the Age, Diabetes, Race, Etiology of cirrhosis, Sex and Severity of liver dysfunction (ADRESS)-HCC risk model [20]
Identification of the cohort In total, 2836 patients were admitted to the First Affiliated Hospital of Soochow University who were diagnosed with cirrhosis from January 2008 to May 2018; 2316 patients were excluded from the study (Fig. 1)
Summary
The Toronto hepatocellular carcinoma (HCC) risk index (THRI) was developed to predict HCC in patients with cirrhosis. Because the majority of patients with HCC are diagnosed at advanced stages [3], few Population-based screening promotes the early identification of high-risk patients for developing HCC [6,7,8]. Both the American Association for the Study of Liver Diseases (AASLD) and the Asian Pacific Association for the Study of the Liver (APASL) suggested a combination of alpha-fetoprotein (AFP) level and ultrasound as monitoring tools for HCC, and a surveillance interval of 6. Several scoring systems and models were developed to predict the risk of HCC, including the Chinese University of Hong Kong (CUHK) clinical scoring system [15]; the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/ Cancer-Hepatitis B Virus (REVEAL-HBV) nomograms [16]; the Guide with Age, Gender, HBV DNA, Core Promoter Mutations and Cirrhosis (GAG-HCC) risk score [17]; the Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B) [18]; the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) model [19]; and the Age, Diabetes, Race, Etiology of cirrhosis, Sex and Severity of liver dysfunction (ADRESS)-HCC risk model [20]
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