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J Hepatol. 2014 Feb;60(2):339-45. doi: 10.1016/j.jhep.2013.09.029. Epub 2013 Oct 12.

Liver stiffness-based optimization of hepatocellular carcinoma risk score in patients with chronic hepatitis B.

Author information

1
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
2
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
3
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: wongv@cuhk.edu.hk.

Abstract

BACKGROUND & AIMS:

CU-HCC score is accurate to predict hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. However, diagnosis of cirrhosis may be incorrect based on ultrasonography, leading to some errors in HCC prediction. This study aimed to evaluate the accuracy of LSM-HCC score, refined from CU-HCC score with liver stiffness measurement (LSM) using transient elastography to predict HCC.

METHODS:

A prospective cohort study of 1555 consecutive CHB patients referred for transient elastography examination; 1035 and 520 patients randomly assigned to training and validation cohorts, respectively. Clinical cirrhosis of CU-HCC score was substituted by LSM and analyzed with multivariable Cox regression analysis with other parameters.

RESULTS:

During a mean follow-up of 69 months, 38 patients (3.7%) in the training cohort and 17 patients (3.4%) in the validation cohort developed HCC. A new LSM-HCC score composed of LSM, age, serum albumin and hepatitis B virus (HBV) DNA levels were derived, which ranges from 0 to 30. Areas under receiver operating characteristic curves of LSM-HCC score were higher than those of CU-HCC score (0.83-0.89 vs. 0.75-0.81). By applying the cutoff value of 11, the score excluded future HCC with high negative predictive value (99.4%-100%) at 5 years.

CONCLUSIONS:

LSM-HCC score constructed from LSM, age, serum albumin and HBV DNA level is accurate to predict HCC in CHB patients.

KEYWORDS:

ALT; AUROC; Anti-HBe; CHB; CI; HBV; HBV DNA; HBeAg; HBsAg; HCC; HR; IQR; LSM; Liver-related mortality; Predication score; Transient elastography; alanine aminotransferase; antibody against hepatitis B e antigen; area under the receiver operating characteristics curve; chronic hepatitis B; confidence intervals; hazard ratios; hepatitis B e antigen; hepatitis B surface antigen; hepatitis B virus; hepatocellular carcinoma; interquartile range; liver stiffness measurement

PMID:
24128413
DOI:
10.1016/j.jhep.2013.09.029
[Indexed for MEDLINE]

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