GES: A validated simple score to predict the risk of HCC in patients with HCV‐GT4‐associated advanced liver fibrosis after oral antivirals

Abstract

Background & Aims: Hepatocellular carcinoma (HCC) risk persists after hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs), particularly in patients with cirrhosis. Identifying those who are likely to develop HCC is a critical unmet medical need. Our aim is to develop a score that offers individualized patient HCC risk prediction. Methods: This two-centre prospective study included 4400 patients, with cirrhosis and advanced fibrosis who achieved a sustained virologic response (SVR), including 2372 patients (derivation cohort). HCC-associated factors were identified by multivariable Cox regression analysis to develop a scoring model for prediction of HCC risk; and subsequently internally and externally validated in two independent cohorts of 687 and 1341 patients. Results: In the derivation cohort, the median follow-up was 23.51 ± 8.21 months, during which 109 patients (4.7%) developed HCC. Age, sex, serum albumin, α fetoprotein and pretreatment fibrosis stage were identified as risk factors for HCC. A simple predictive model (GES) score was constructed. The 2-year cumulative HCC incidence using Kaplan-Meier method was 1.2%, 3.3% and 7.1% in the low-risk, medium-risk and high-risk groups respectively. Internal and external validation showed highly significant difference among the three risk groups (P < .001) with regard to cumulative HCC risk. GES score has high predictive ability value (Harrell's C statistic 0.801), that remained robustly consistent across two independent validation cohorts (Harrell's C statistic 0.812 and 0.816). Conclusion: GES score is simple with validated good predictive ability for the development of HCC after eradication of HCV and may be useful for HCC risk stratification in those patients.

Pretreatment non‐hypervascular hypointense nodules on Gd‐EOB‐DTPA‐enhanced MRI as a predictor of hepatocellular carcinoma development after sustained virologic response in HCV infection

“…Although previous studies reported that the size of NHHN is associated with hypervascularisation, 8 this association was not observed in this study, even though the size of NHHNs increased with hypervascularisation. In contrast, serum AFP levels, a reported risk factor for HCC development after SVR, 15‐17 were significantly higher in patients whose NHHNs hypervascularised than in patients whose NHHNs did not.…”

Predicting Hepatocellular Carcinoma Risk in Patients with Chronic HCV Infection and a Sustained Virological Response to Direct-Acting Antivirals

“…Finally, 5 authors reported data on patients with advanced fibrosis, defined through histology (F3-F4), non-invasive tests or criteria for chronic advanced liver disease (cACLD) 11 , 36 , 43–46 ( Table 2 ). Eight out of these studies enrolled only patients with an SVR, 10 , 21 , 30 , 33 , 37 , 44–46 whilst in one study data could be extrapolated. 34 In studies including also non-SVR patients, rates of treatment failure ranged between 1.9% and 10% ( Table 2 ).…”

“… 38 Thus, among indirect markers of PH were both biochemical tests and clinical features. For example, albumin 20 , 31 , 37 , 44 , 45 and PLT 20 , 21 , 27 , 29 were independently associated with HCC occurrence, either as single predictors or when included in predictive scores ( Tables 6 and 7 ). The presence of esophageal varices (EV) 28 or ascites was associated with an increased the risk of de-novo HCC.…”

Nachbetreuung von PatientInnen mit „sustained virologic response“

“…der "AST to platelet ratio index" (APRI; [34,[39][40][41]), eine niedrige Thrombozytenzahl als Marker der portalen Hypertension [33,46] sowie ein niedriges Serumalbumin als Maß der reduzierten Lebersynthe-seleistung, waren mit einem erhöhten HCC-Risiko assoziiert [7,33]. Letztendlich zeigte auch das α-Fetoprotein (AFP), ein in Österreich häufig angewandter Biomarker/Tumormarker für das Vorliegen eines HCC, einen prädiktiven Wert [39,43,[47][48][49]. Bezüglich aller dieser Parameter bleibt jedoch abzuwarten, welche Kombination(en) schlussendlich die höchste Genauigkeit aufweisen werden.…”

“…Bezüglich aller dieser Parameter bleibt jedoch abzuwarten, welche Kombination(en) schlussendlich die höchste Genauigkeit aufweisen werden. Hier konnte bereits eine Arbeit aus Ägypten eine große Studienpopulation anhand des Geschlechts (männlich), Alters (≥54 Jahre), Fibrosestadiums, Serumalbumins (<3,8 g/dl) und des AFP(>20 ng/ml) in 3 Risikogruppen mit unterschiedlich hohem HCC-Risiko einteilen [47]. Eine andere Studie aus Spanien entwarf 2 Scores, die jeweils eine gute Vorhersagekraft bezüglich HCC aufwiesen.…”