Simple model predicts indeterminate nodule progression in HBV-related cirrhosis
medwireNews: South Korean researchers have developed a risk score based on routine baseline clinical data that can assess the risk of progression to hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV)-related cirrhosis harboring indeterminate nodules.
This model could aid clinical decision making in these patients, and “could provide comprehensive and individualized medicine for each patient with HBV-related cirrhosis,” they write in The American Journal of Gastroenterology.
The team analyzed data from 356 patients, with a total of 373 indeterminate nodules revealed by dynamic liver computed tomography, where an indeterminate nodule was defined as a lesion no larger than 2 cm with undetermined malignant potential. During a median follow-up of 36 months, 16.6% of the nodules developed into HCC.
In multivariate analysis, older age, presence of arterial enhancement, history of HCC, and hepatitis B e antigen positivity were significantly linked to HCC progression, with corresponding hazard ratios (HRs) of 1.05 (per year; p=0.0033), 2.45 (p=0.001), 4.57 (p=0.006), and 2.30 (p=0.006).
Large nodule size (>1 cm), low serum albumin levels (≤3.5 g/dL), and high serum α-fetoprotein levels (≥100 ng/ml), were also identified as significant risk factors for progression to HCC, with HRs of 7.44 (p<0.001), 2.14 (p=0.024), and 4.43 (p=0.012), respectively.
Lead researcher Sung Won Cho (Ajou University School of Medicine, Suwon) and team used these parameters to develop a model that predicted the risk for HCC progression at 3 and 5 years with an accuracy of 87.9% and 92.2%, respectively. These findings were confirmed in a leave-one-out cross-validation analysis, which gave corresponding accuracy values of 88.6% and 92.0%.
Using the risk model, patients were categorized as low, intermediate, or high risk, with a cumulative incidence of HCC development at 2 years of 0%, 9.2%, and 41.6%, respectively, rising to 1.0%, 14.5%, and 63.1%, respectively, at 5 years.
Noting that the 5-year HCC progression rate in the low-risk group was not significantly greater than at 2 years, Cho et al suggest that nodular lesions in these patients “could be followed up by [a] regular surveillance schedule.”
However, they recommend an “aggressive diagnostic approach” using biopsy or magnetic resonance imaging for patients classed as high risk, among whom even the 2-year HCC progression rate was approximately 40%.
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