General evaluation score for predicting the development of hepatocellular carcinoma in patients with advanced liver fibrosis associated with hepatitis C virus genotype 1 or 2 after direct‐acting antiviral therapy
Toshifumi Tada,
Masayuki Kurosaki,
Nobuharu Tamaki,
Yutaka Yasui,
Nami Mori,
Keiji Tsuji,
Chitomi Hasebe,
Koji Joko,
Takehiro Akahane,
Koichiro Furuta,
Haruhiko Kobashi,
Hideki Fujii,
Toru Ishii,
Hiroyuki Marusawa,
Masahiko Kondo,
Yuji Kojima,
Hideo Yoshida,
Yasushi Uchida,
Shinichiro Nakamura,
Namiki Izumi
Affiliations
Toshifumi Tada
Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
Masayuki Kurosaki
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Nobuharu Tamaki
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Yutaka Yasui
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Nami Mori
Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic‐Bomb Survivors Hospital Hiroshima Japan
Keiji Tsuji
Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic‐Bomb Survivors Hospital Hiroshima Japan
Chitomi Hasebe
Department of Gastroenterology Japanese Red Cross Asahikawa Hospital Asahikawa Japan
Koji Joko
Center for Liver‐Biliary‐Pancreatic Disease Matsuyama Red Cross Hospital Matsuyama Japan
Takehiro Akahane
Department of Gastroenterology Japanese Red Cross Ishinomaki Hospital Ishinomaki Japan
Koichiro Furuta
Department of Gastroenterology Masuda Red Cross Hospital Masuda Japan
Haruhiko Kobashi
Department of Gastroenterology Japanese Red Cross Okayama Hospital Okayama Japan
Hideki Fujii
Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Kyoto Japan
Toru Ishii
Department of Gastroenterology Japanese Red Cross Akita Hospital Akita Japan
Hiroyuki Marusawa
Department of Gastroenterology and Hepatology Japanese Red Cross Osaka Hospital Osaka Japan
Masahiko Kondo
Department of Gastroenterology Japanese Red Cross Otsu Hospital Otsu Shiga Japan
Yuji Kojima
Department of Hepatology Japanese Red Cross Ise Hospital Ise Japan
Hideo Yoshida
Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan
Yasushi Uchida
Department of Gastroenterology Japanese Red Cross Matsue Hospital Matsue Japan
Shinichiro Nakamura
Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
Namiki Izumi
Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
Abstract Background and Aim To validate a composite predictive model for hepatocellular carcinoma (HCC) development in patients with advanced liver fibrosis associated with chronic hepatitis C virus (HCV) who have received direct‐acting antiviral (DAA) therapy and achieved sustained virologic response (SVR). Methods This study included 1258 patients with advanced liver fibrosis associated with HCV genotype 1, 2, or both. General evaluation score (GES), which is based on sex, age, fibrosis stage, albumin, and α‐fetoprotein, was used as a composite predictive model. Results There were 645 (51.3%) patients in the low‐risk group, 228 (18.1%) in the intermediate‐risk group, and 385 (30.6%) in the high‐risk group based on GES categories. The 12‐, 36‐, and 60‐month cumulative incidence of HCC was 0.7%, 5.3%, and 13.0%, respectively. Multivariable analysis with Cox proportional hazards models showed that male sex (hazard ratio [HR], 1.863; 95% confidence interval [CI], 1.204–2.883), F4 fibrosis stage (HR, 3.199; 95% CI, 1.696–6.036), and albumin (HR, 0.489; 95% CI, 0.288–0.828) are independently associated with HCC development. The incidence of HCC differed significantly by GES‐based risk category (P < 0.001). Cox proportional hazards models showed that, with the low‐risk group as the referent, the HR for HCC development was 1.875 (95% CI, 1.000–3.514) in the intermediate‐risk group and 2.819 (95% CI, 1.716–4.630) in the high‐risk group. GES had better predictive ability for HCC development than fibrosis‐4 index according to time‐dependent receiver operating characteristic analysis. Conclusion GES is useful for predicting HCC development in patients with advanced liver fibrosis after SVR.
