The Age, Gamma-Glutamyl Transpeptidase and Platelet Index: A Novel Noninvasive Model for Predicting Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Liver Cirrhosis

Abstract

Kai Liu,1,2 Zeyu Huang,1 Suhua Yang,1,2 Lin Lin,1 Shuqin Zheng,1,3 Xiujun Zhang,1,3 Yuan Xue,1,2 Weibin Xie1,4 1Institute of Hepatology, the Third People’s Hospital of Changzhou, Changzhou, People’s Republic of China; 2Department of Infectious Diseases, the Third People’s Hospital of Changzhou, Changzhou, People’s Republic of China; 3Department of Liver Diseases, the Third People’s Hospital of Changzhou, Changzhou, People’s Republic of China; 4Department of Anesthesiology, the Third People’s Hospital of Changzhou, Changzhou, People’s Republic of ChinaCorrespondence: Yuan Xue, Institute of Hepatology, the Third People’s Hospital of Changzhou, No. 300 Lanling North Road, Changzhou, Jiangsu, 213000, People’s Republic of China, Tel [phone], Email [email protected] Weibin Xie, Department of Anesthesiology, The Third People’s Hospital of Changzhou, No. 300 Lanling North Road, Changzhou, 213000, Jiangsu, People’s Republic of China, Tel [phone], Email [email protected] and Aims: High incidence of hepatocellular carcinoma (HCC) exists in patients with liver cirrhosis (LC), but the predictive accuracy of noninvasive scoring systems (NSSs) is yet to be elucidated. The present study aimed to evaluate the predictive ability of fibrosis-4 (FIB-4), aminotransferase-to-platelet ratio index (APRI), and gamma-glutamyl transpeptidase to platelet ratio (GPR) in patients with LC, and to establish a new model with more accuracy.Methods: Data from 94 patients with compensated LC and 134 patients with decompensated cirrhosis (DC) were collected. The prediction accuracy of NSSs, including APRI, GPR, and FIB-4, was compared.Results: During a median follow-up of 37.5 months, 9 patients in the compensated LC group and 38 in the DC group developed HCC. For 228 patients, the area under the receiver operating characteristic curve (AUROC) of APRI, GPR, and FIB-4 was 0.596, 0.625, and 0.654, respectively. Multivariable logistic analysis showed that age, gamma-glutamyl transpeptidase (GGT), and platelet (PLT) were independent risk factors for HCC development, and a new model encompassing age, GGT, and PLT was superior to NSSs (all P< 0.05). With an optimal cutoff value of 0.216, Model (Age_GGT_PLT) achieved 68.09% sensitivity and 69.61% specificity.Conclusion: NSSs, including APRI, GPR, and FIB-4, has a non-optimal accuracy in predicting HCC development in patients with HBV-related LC. Thus, the new model consisting of age, GGT, and PLT may be more accurate than NSSs.Keywords: hepatocellular carcinoma, risk score, liver cirrhosis, decompensated cirrhosis, gamma-glutamyl transpeptidase

Keywords

• hepatocellular carcinoma
• risk score
• liver cirrhosis
• decompensated cirrhosis
• gamma-glutamyl transpeptidase