A new model predicts hepatocellular carcinoma in patients with HBV-related decompensated liver cirrhosis and long-term antiviral therapy: a prospective study

Hao-Dan Mao; Shu-Qin Zheng; Su-Hua Yang; Ze-Yu Huang; Yuan Xue; Min Zhou

doi:10.7717/peerj.15014

A new model predicts hepatocellular carcinoma in patients with HBV-related decompensated liver cirrhosis and long-term antiviral therapy: a prospective study

PeerJ. 2023 Mar 24:11:e15014. doi: 10.7717/peerj.15014. eCollection 2023.

Authors

Hao-Dan Mao^{1

2}, Shu-Qin Zheng¹, Su-Hua Yang^{1

2}, Ze-Yu Huang^{1

2}, Yuan Xue^{1

2}, Min Zhou^{1

2}

Affiliations

¹ Institute of Hepatology, Changzhou Third People's Hospital, Changzhou, Jiangsu, China.
² Department of Infectious Diseases, Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China.

Abstract

Background: We aimed to evaluate the prediction values of non-invasive models for hepatocellular carcinoma (HCC) development in patients with HBV-related liver cirrhosis (LC) and long-term NA treatment.

Methods: Patients with compensated or decompensated cirrhosis (DC), who achieved long-term virological response, were enrolled. DC and its stages were defined by the complications including ascites, encephalopathy, variceal bleeding, or renal failure. Prediction accuracy of several risk scores, including ALBI, CAMD, PAGE-B, mPAGE-B and aMAP, was compared.

Results: The median follow-up duration was 37 (28-66) months. Among the 229 patients, 9 (9.57%) patients in the compensated LC group and 39 (28.89%) patients in the DC group developed HCC. The incidence of HCC was higher in the DC group ( $X$ ² = 12.478, P < 0.01). The AUROC of ALBI, aMAP, CAMD, PAGE-B and mPAGE-B scores were 0.512, 0.667, 0.638, 0.663, 0.679, respectively. There was no significant difference in AUROC between CAMD, aMAP, PAGE-B and mPAGE-B (all P > 0.05). Univariable analysis showed that age, DC status and platelet were associated with HCC development, and multivariable analysis showed that age and DC status (both P < 0.01) were independent risk factors for HCC development, then Model (Age_DC) was developed and its AUROC was 0.718. Another model, Model (Age_DC_PLT_TBil) consisting of age, DC stage, PLT, TBil was also developed, and its AUROC was larger than that of Model (Age_DC) (0.760 vs. 0.718). Moreover, AUROC of Model (Age_DC_PLT_TBil) was larger than the other five models (all P < 0.05). With an optimal cut-off value of 0.236, Model (Age_DC_PLT_TBil) achieved 70.83% sensitivity, 76.24% specificity.

Conclusion: There is a lack of non-invasive risk scores for HCC development in HBV-related DC, and a new model consisting of age, DC stage, PLT, TBil may be an alternative.

Keywords: Decompensated cirrhosis; Hepatocellular carcinoma; Liver cirrhosis; Prediction; Risk score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / therapeutic use
Carcinoma, Hepatocellular* / epidemiology
Esophageal and Gastric Varices* / epidemiology
Gastrointestinal Hemorrhage / complications
Hepatitis B virus
Humans
Liver Cirrhosis / complications
Liver Neoplasms* / epidemiology
Prospective Studies

Substances

Antiviral Agents

Grants and funding

This work was supported by the 333 High-level Talents Project of Jiangsu Province (No. LGY2020032), the Science and Technology Project of Changzhou (No. CE20225040), and Qingmiao Talents Cultivation Project of Changzhou Health Commission (No. CZQM2020089). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.