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Predictive performance and clinical utility of HCC risk scores in chronic hepatitis C: a comparative study

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Abstract

Background and aim

Many HCC risk prediction scores were developed to guide HCC risk stratification and identify CHC patients who either need intensified surveillance or may not require screening. There is a need to compare different scores and their predictive performance in clinical practice. We aim to compare the newest HCC risk scores evaluating their discriminative ability, and clinical utility in a large cohort of CHC patients.

Patients and methods

The performance of the scores was evaluated in 3075 CHC patients who achieved SVR following DAAs using Log rank, Harrell’s c statistic, also tested for HCC-risk stratification and negative predictive values.

Results

HCC developed in 212 patients within 5 years follow-up. Twelve HCC risk scores were identified and displayed significant Log rank (p ≤ 0.05) except Alonso-Lopez TE-HCC, and Chun scores (p = 0.374, p = 0.053, respectively). Analysis of the remaining ten scores revealed that ADRES, GES pre-post treatment, GES algorithm and Watanabe (post-treatment) scores including dynamics of AFP, were clinically applicable and demonstrated good statistical performance; Log rank analysis < 0.001, Harrell’s C statistic (0.66–0.83) and high negative predictive values (94.38–97.65%). In these three scores, the 5 years cumulative IR in low risk groups be very low (0.54–1.6), so screening could be avoided safely in these patients.

Conclusion

ADRES, GES (pre- and post-treatment), GES algorithm and Watanabe (post-treatment) scores seem to offer acceptable HCC-risk predictability and clinical utility in CHC patients. The dynamics of AFP as a component of these scores may explain their high performance when compared to other scores.

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Author information

Authors and Affiliations

  1. Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, Mansoura, Egypt

    Gamal Shiha, Nabiel N. H. Mikhail, Reham Soliman & Ayman Hassan

  2. Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Gamal Shiha

  3. Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

    Nabiel N. H. Mikhail

  4. Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt

    Reham Soliman

  5. Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia

    Mohammed Eslam

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  1. Gamal Shiha
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  4. Ayman Hassan
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  5. Mohammed Eslam
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Contributions

GS designed the study. GS and RS supervised clinical work. NM performed the statistical analyses. GS, NM, RS, AH and ME interpreted the data. AH supervised the laboratory work. All authors drafted the paper provided input into the manuscript and approved the final version.

Corresponding author

Correspondence to Gamal Shiha.

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Conflict of interest

Gamal Shiha, Nabiel N. H. Mikhail, Reham Soliman, Ayman Hassan and Mohammed Eslam declare no conflicts of interest.

Ethical approval

This study was conducted in accordance with the protocol and the principles of the Declaration of Helsinki [12] and its amendments in 2008. The protocol was approved by the Institutional Research Board of ELRIAH (IORG0008819, IRB00010534) in accordance with the local regulations. The need to obtain informed consent from the participants was waived by the IRB due to the retrospective nature of the study.

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Shiha, G., Mikhail, N.N.H., Soliman, R. et al. Predictive performance and clinical utility of HCC risk scores in chronic hepatitis C: a comparative study. Hepatol Int 16, 159–170 (2022). https://doi.org/10.1007/s12072-021-10284-6

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  • DOI: https://doi.org/10.1007/s12072-021-10284-6

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