JGH Open (Jul 2022)

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

DOI
https://doi.org/10.1002/jgh3.12778
Journal volume & issue
Vol. 6, no. 7
pp. 487 – 495

Abstract

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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.

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