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03-08-2018 | HBV | News | Article

HCC risk score developed for patients with chronic hepatitis B virus

medwireNews: Researchers have developed and validated a score for predicting the risk for hepatocellular carcinoma (HCC) in Asian patients with chronic hepatitis B virus (HBV) infection who are taking oral antiviral therapy.

The “easily calculable” CAMD (cirrhosis, age, male sex, and diabetes mellitus) score requires routinely available information and ranges from 0 to 19 points, with patients scoring below 8 points exposed to significantly lower risks for HCC and those scoring above 13 points exposed to significantly higher risks.

The team reports in the Journal of Hepatology that the CAMD score was able to distinguish the risk for HCC with a concordance rate of around 75–80% during the first 3 years of therapy and the risk prediction could be extrapolated to 5 years with a similar level of accuracy.

“A score lower than 8 points that predicts an average annual incidence below 0.3% may spare the patients from HCC surveillance while on therapies; this might obviate diagnostic workup that is potentially harmful and hardly cost-effective,” comment researchers Grace Lai-Hung Wong (Prince of Wales Hospital, Shatin, Hong Kong) and team.

“In contrast, a score higher than 13 points not only heralds the necessity of intensive surveillance to detect HCC at an early stage, but also indicates the unmet need of novel strategies beyond viral suppression to reduce the risk further.”

The score was developed using population-wide data from Taiwan on 23,851 patients with chronic HBV infection receiving entecavir or tenofovir treatment. Of these, 596 (2.50%) developed HCC with a cumulative incidence of 3.56% at 3 years.

Cox proportional hazards modelling identified cirrhosis, age, and an interaction between the two, as well as male sex and diabetes as independent risk factors for HCC.

Indeed, compared with patients without cirrhosis, those with cirrhosis who were aged below 40 years had a significant 18.8 times greater risk for HCC, while the risk for those with cirrhosis aged older than 40 years was increased 4.6-fold.

Being older than 40 years of age compared with younger also increased the risk for HCC: 4.5-fold for those aged 40–49 years, ninefold for those aged 50–59 years, and 15.9-fold for those aged 60 years and older. And male gender and having diabetes increased the risk 1.8- and 1.3-fold, respectively.

The regression coefficients were weighted to generate risk scores for the different factors, ranging from 10 points for having cirrhosis and being older than 40 years of age to 1 point for having diabetes.

The total CAMD score distinguished between those who did and did not develop HCC with 82­–83% accuracy during the first 3 years of treatment and enabled patients to be stratified into low (<8 points), intermediate (8–13 points), or high (>13 points) risk groups for HCC.

The corresponding average annual incidences of HCC for these three risk groups during the first 3 years of treatment were 0.09%, 0.85%, and 4.06% (all p<0.0001).

The findings were similar when the CAMD score was externally validated in an independent cohort of 19,321 HBV patients from Hong Kong, who had differing baseline demographics; demonstrating the generalizability of the risk score.

In this cohort, the score discriminated the risk for HCC with an accuracy of 75–76% during the first 3 years of treatment and with an accuracy of 76% in the extrapolated fourth and fifth years.

The researchers conclude: “By stratifying patients at different risks of HCC, the easily applicable score may inform the clinical practice and healthcare policy in the era of antiviral treatment for [chronic HBV].”

By Lucy Piper

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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