TitleaMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis
AuthorsFan, Rong
Papatheodoridis, George
Sun, Jian
Innes, Hamish
Toyoda, Hidenori
Xie, Qing
Mo, Shuyuan
Sypsa, Vana
Guha, Indra Neil
Kumada, Takashi
Niu, Junqi
Dalekos, George
Yasuda, Satoshi
Barnes, Eleanor
Lian, Jianqi
Suri, Vithika
Idilman, Ramazan
Barclay, Stephen T.
Dou, Xiaoguang
Berg, Thomas
Hayes, Peter C.
Flaherty, John F.
Zhou, Yuanping
Zhang, Zhengang
Buti, Maria
Hutchinson, Sharon J.
Guo, Yabing
Calleja, Jose Luis
Lin, Lanjia
Zhao, Longfeng
Chen, Yongpeng
Janssen, Harry L. A.
Zhu, Chaonan
Shi, Lei
Tang, Xiaoping
Gaggar, Anuj
Wei, Lai
Jia, Jidong
Irving, William L.
Johnson, Philip J.
Lampertico, Pietro
Hou, Jinlin
AffiliationSouthern Med Univ, Nanfang Hosp, Dept Infect Dis, State Key Lab Organ Failure Res,Guangdong Prov Ke, Guangzhou, Peoples R China
Natl & Kapodistrian Univ Athens, Laiko Gen Hosp, Dept Gastroenterol, Med Sch, Athens, Greece
Glasgow Caledonian Univ, Sch Hlth & Life Sci, Glasgow, Lanark, Scotland
Ogaki Municipal Hosp, Dept Gastroenterol & Hepatol, Ogaki, Japan
Shanghai Jiao Tong Univ, Ruijin Hosp, Dept Infect Dis, Sch Med, Shanghai, Peoples R China
Gilead Sci, Foster City, CA USA
Natl & Kapodistrian Univ Athens, Dept Hyg Epidemiol & Med Stat, Med Sch, Athens, Greece
Nottingham Univ Hosp NHS Trust, NIHR Nottingham Biomed Res Ctr, Nottingham, England
Univ Nottingham, Nottingham, England
Gifu Kyoritsu Univ, Dept Nursing, Ogaki, Japan
Jilin Univ, Hosp 1, Dept Hepatol, Changchun, Peoples R China
Thessalia Univ, Dept Internal Med, Med Sch, Larisa, Greece
Univ Oxford, Nuffield Dept Med, Peter Medawar Bldg Pathogen Res, Oxford, England
Univ Oxford, Oxford NIHR Biomed Res Ctr, Oxford, England
Fourth Mil Med Univ, Tangdu Hosp, Ctr Infect Dis, Xian, Peoples R China
Univ Ankara, Dept Gastroenterol, Med Sch, Ankara, Turkey
Glasgow Royal Infirm, Glasgow, Lanark, Scotland
China Med Univ, Dept Infect Dis, Shengjing Hosp, Shenyang, Peoples R China
Univ Clin Leipzig, Div Hepatol, Clin & Polyclin Gastroenterol Hepatol Infect Dis, Leipzig, Germany
Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland
Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Gastroenterol, Wuhan, Peoples R China
Hosp Gen Univ Valle Hebron & Ciberehd, Barcelona, Spain
Hosp U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain
Shanxi Med Univ, Dept Infect Dis, Hosp 1, Taiyuan, Peoples R China
Univ Hlth Network, Toronto Western & Gen Hosp, Liver Clin, Toronto, ON, Canada
Hangzhou YITU Healthcare Technol Co Ltd, Big Data Res & Biostat Ctr, Hangzhou, Peoples R China
Guangzhou Eighth Peoples Hosp, Guangzhou, Peoples R China
Peking Univ, Hepatol Inst, Peoples Hosp, Beijing, Peoples R China
Capital Med Univ, Beijing Friendship Hosp, Liver Res Ctr, Beijing, Peoples R China
Univ Liverpool, Dept Mol & Clin Canc Med, 2nd Floor Sherrington Bldg,Ashton St, Liverpool L69 3GE, Merseyside, England
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, CRC AM & A Migliavacca Ctr Liver Dis, Milan, Italy
Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy
Issue DateDec-2020
AbstractBackground & Aims: Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis. Methods: A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686). Results: We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin-bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%. Conclusions: This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide. Lay summary: In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin-bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V.
Appears in Collections:人民医院

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