Liver Stiffness-Based Risk Prediction Model for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease

Abstract

Non-alcoholic fatty liver disease (NAFLD) is associated with an increased hepatocellular carcinoma (HCC) risk. We established and validated a liver stiffness (LS)-based risk prediction model for HCC development in patients with NAFLD. A total of 2666 and 467 patients with NAFLD were recruited in the training and validation cohorts, respectively. NAFLD was defined as controlled attenuated parameter ≥238 dB/m by transient elastography. Over a median of 64.6 months, HCC developed in 22 (0.8%) subjects in the training cohort. Subjects who developed HCC were older and had higher prevalence of diabetes and cirrhosis, lower platelet count, and higher AST levels compared to those who did not develop HCC (all p < 0.05). In multivariate analysis, age ≥60 years (hazard ratio (HR) = 9.1), platelet count <150 × 103/μL (HR = 3.7), and LS ≥9.3 kPa (HR = 13.8) were independent predictors (all p < 0.05) that were used to develop a risk prediction model for HCC development, together with AST ≥34 IU/L. AUCs for predicting HCC development at 2, 3, and 5 years were 0.948, 0.947, and 0.939, respectively. This model was validated in the validation cohort (AUC 0.777, 0.781, and 0.784 at 2, 3, and 5 years, respectively). The new risk prediction model for NAFLD-related HCC development showed acceptable performance in the training and validation cohorts.

Influence of extracellular matrix composition on tumour cell behaviour in a biomimetic in vitro model for hepatocellular carcinoma

“…Changes in ECM composition are one of the characterizing features of the TME and it is widely accepted that this actively contributes to disease progression in different tumors 20,21 . This significance of altered ECM is seen in HCC patients, where increases in liver stiffness are associated with hepatic dysfunction, poor prognosis, and survival [22][23][24] . Recent studies have even shown that increased liver stiffness is a predictor for mortality and need for mechanical ventilation among patients hospitalized with COVID-19 25 .…”

A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study

“…Unlike previous studies [ 37 , 38 ], age was not a predictor for patients with AoCLD in our study, which could be attributed to study population heterogeneity. In previous studies [ 37 , 39 , 40 ] including all age groups, age is a parameter of the prognostic indicator, usually as a dichotomous or multi-categorical variable. However, our model was based primarily on data from people >60 years of age.…”

Risk factors and diagnostic biomarkers for nonalcoholic fatty liver disease-associated hepatocellular carcinoma: Current evidence and future perspectives

“…Therefore, integrating multiple factors will improve the accuracy of risk assessment. Lee et al [ 45 ] proposed a risk prediction model consisting of age, platelet count, and liver stiffness. This showed relatively good prediction performance in the validation cohort ( i.e., area under the receiver operating characteristic curve (AUROC), 0.78)[ 45 ].…”

“…Lee et al [ 45 ] proposed a risk prediction model consisting of age, platelet count, and liver stiffness. This showed relatively good prediction performance in the validation cohort ( i.e., area under the receiver operating characteristic curve (AUROC), 0.78)[ 45 ]. Ioannou et al [ 46 ] reported another prediction model with a similar predictive value (AUROC, 0.75), consisting of age, sex, diabetes, BMI, platelet count, serum albumin, and AST/√ALT ratio[ 46 ].…”