New Score Gauges HCC Risk in Patients With Chronic Hepatitis B

Incorporating a patient’s noninvasive fibrosis response to antiviral therapy, researchers have developed a new score to predict hepatocellular carcinoma risk more reliably in patients with chronic hepatitis B. The findings are published in the August 2021 issue of The American Journal of Gastroenterology.

“Antiviral therapy improves hepatic fibrosis and reduces hepatocellular carcinoma incidence,” researchers wrote. “This study aimed to evaluate whether on-therapy changes in scores for fibrosis index based on four factors and aspartate aminotransferase-to-platelet ratio index are associated with hepatocellular carcinoma development and establish a hepatocellular carcinoma risk score model incorporating noninvasive fibrosis marker response.”

The study included a total 5147 patients with chronic hepatitis B prescribed entecavir/tenofovir for more than 12 months. Ten-year cumulative hepatocellular carcinoma incidence rates were 12.6% in the derivation cohort, which included 4028 patients, and 13.7% in the validation cohort of 1119 patients.

Patients who achieved a significant decrease in noninvasive fibrosis markers by 12 months had a marked reduction in hepatocellular carcinoma risk, the study showed. Consequently, researchers combined early noninvasive fibrosis marker response with several other independent predictors of hepatocellular carcinoma to develop what they called the Fibrosis marker response, Sex, Age, and Cirrhosis (FSAC) score to gauge patient risk of developing the cancer.

According to the study, the FSAC demonstrated a 0.84 C-index value for 10-year prediction of hepatocellular carcinoma, compared with C-index values of 0.77 for PAGE-B, 0.80 for modified PAGE-B, 0.77 for CU-HCC, and 0.67 for REACH-B. The FSAC score’s predictive performance was corroborated in the validation cohort, researchers reported, in which the FSAC again achieved higher C-index values than the other models.

“FSAC incorporating noninvasive fibrosis marker response is a reliable risk score for risk estimation for hepatocellular carcinoma,” researchers concluded, “with better performance than other models.”

—Jolynn Tumolo

Reference:

Nam H, Lee SW, Kwon JH, et al. Prediction of hepatocellular carcinoma by on-therapy response of noninvasive fibrosis markers in chronic hepatitis B. Am J Gastroenterol. 2021;116(8):1657-1666.