aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis.
Fan R., Papatheodoridis G., Sun J., Innes H., Toyoda H., Xie Q., Mo S., Sypsa V., Guha IN., Kumada T., Niu J., Dalekos G., Yasuda S., Barnes E., Lian J., Suri V., Idilman R., Barclay ST., Dou X., Berg T., Hayes PC., Flaherty JF., Zhou Y., Zhang Z., Buti M., Hutchinson SJ., Guo Y., Calleja JL., Lin L., Zhao L., Chen Y., Janssen HLA., Zhu C., Shi L., Tang X., Gaggar A., Wei L., Jia J., Irving WL., Johnson PJ., Lampertico P., Hou J.
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for chronic hepatitis patients. METHODS: A total of 17,374 patients, comprising 10,578 treated Asian chronic hepatitis B (CHB) patients, 2510 treated Caucasian CHB patients, 3566 treated hepatitis C virus (HCV)-infected patients (including 2489 patients with cirrhosis achieving a sustained virologic response) and 720 non-viral hepatitis (NVH) patients from 11 international prospective observational cohorts or randomized controlled trials, were divided into a training cohort (3688 Asian CHB patients) and 9 validation cohorts with different aetiologies and ethnicities (N =13,686). RESULTS: We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, Male, Albumin-bilirubin and Platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies but also in those with different ethnicities (c-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (N=7413, 43.6%), medium- (N=6529, 38.4%), and high-risk (N =3044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%. CONCLUSIONS: This objective, simple, reliable risk score based on five common parameters accurately predicts HCC development, regardless of aetiology and ethnicity, which may help to establish a risk score-guided HCC surveillance strategy worldwide.