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J Hepatol. 2009 Jan;50(1):80-8. doi: 10.1016/j.jhep.2008.07.023. Epub 2008 Sep 21.

Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B.

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  • 1Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. mfyuen@hkucc.hku.hk

Abstract

BACKGROUND/AIMS:

To determine whether gender, age, hepatitis B virus genotype, core promoter and precore mutations, HBeAg/ anti-HBe status, HBV DNA, ALT levels and cirrhosis on presentation were independent risk factors and derive a novel risk score for the development of HCC.

METHODS:

CHB patients (820) were followed up (mean duration 76.8 months) for the occurrence of HCC.

RESULTS:

The 5- and 10-year prevalence of HCC were 4.4% and 6.3%, respectively. Cox regression analysis showed that male gender (p = 0.025, RR 2.98), increasing age (p < 0.001, RR 1.07), higher HBV DNA levels (p = 0.02, RR 1.28), core promoter mutations (p = 0.007, RR 3.66), and presence of cirrhosis (p < 0.001, RR 7.31) were independent risks for the development of HCC. A risk score was derived and validated with sensitivity > 84% and specificity > 76% to predict the 5- and 10- year risks for the development of HCC. The AUC for the 5- and 10-year prediction were 0.88 and 0.89, respectively.

CONCLUSIONS:

The risk score, based on age, gender, HBV DNA levels, core promoter mutations and cirrhosis, can estimate the chance of development of HCC in 5 and 10 years after presentation. It can be used to identify high-risk CHB patients for treatment and screening of HCC.

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