Risk Stratification Model for Hepatocellular Cancer in Patients With Cirrhosis

Authors

Fasiha Kanwal
Saira Khaderi
Amit G Singal
Jorge A Marrero
Sumeet K Asrani
Christopher I Amos
Aaron P Thrift
Jennifer R Kramer
Xian Yu
Yumei Cao
Michelle Luster
Abeer Al-Sarraj
Jing Ning
Hashem B El-Serag

Publication Date

12-1-2023

Journal

Clinical Gastroenterology and Hepatology

DOI

10.1016/j.cgh.2023.04.019

PMID

37390101

PMCID

PMC10661677

PubMedCentral® Posted Date

2-16-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Female, Middle Aged, Male, Liver Neoplasms, Carcinoma, Hepatocellular, Prospective Studies, Liver Cirrhosis, Risk Factors, Risk Assessment, rediction, validation, personalized, liver cancer

Abstract

BACKGROUND & AIMS: The available risk stratification indices for hepatocellular cancer (HCC) have limited applicability. We developed and externally validated an HCC risk stratification index in U.S. cohorts of patients with cirrhosis.

METHODS: We used data from 2 prospective U.S. cohorts to develop the risk index. Patients with cirrhosis were enrolled from 8 centers and followed until development of HCC, death, or December 31, 2021. We identified an optimal set of predictors with the highest discriminatory ability (C-index) for HCC. The predictors were refit using competing risk regression and its predictive performance was evaluated using the area under the receiver-operating characteristic curve (AUROC). External validation was performed in a cohort of 21,550 patients with cirrhosis seen in the U.S Veterans Affairs system between 2018 and 2019 with follow-up through 2021.

RESULTS: We developed the model in 2431 patients (mean age 60 years, 31% women, 24% cured hepatitis C, 16% alcoholic liver disease, and 29% nonalcoholic fatty liver disease). The selected model had a C-index of 0.77 (95% confidence interval [CI], 0.73-0.81), and the predictors were age, sex, smoking, alcohol use, body mass index, etiology, α-fetoprotein, albumin, alanine aminotransferase, and platelet levels. The AUROCs were 0.75 (95% CI, 0.65-0.85) at 1 year and 0.77 (95% CI, 0.71-0.83) at 2 years, and the model was well calibrated. In the external validation cohort, the AUROC at 2 years was 0.70 with excellent calibration.

CONCLUSION: The risk index, including objective and routinely available risk factors, can differentiate patients with cirrhosis who will develop HCC and help guide discussions regarding HCC surveillance and prevention. Future studies are needed for additional external validation and refinement of risk stratification.

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