Model can predict, stratify liver cancer risk in noncirrhotic chronic hepatitis B

A new prognostic model can predict and stratify hepatocellular carcinoma (HCC) risk in noncirrhotic adult patients with chronic hepatitis B (CHB), according to a study published online Sept. 17 in the Annals of Internal Medicine.

Gi-Ae Kim, M.D., Ph.D., from Kyung Hee University Hospital in Seoul, South Korea, and colleagues developed and externally validated a prognostic model for HCC risk in noncirrhotic adult patients with CHB, without notable alanine aminotransferase (ALT) elevation.

The model was developed in 6,949 patients with CHB from a Korean hospital-based cohort, and was validated externally among 7,429 patients with CHB combined from the Taiwanese cohort and seven cohorts from Korea and Hong Kong.

The researchers found that the derivation and validation cohorts identified 435 and 467 incident HCC cases over 10 and 12 years, respectively. One of the strongest predictors of HCC development was baseline hepatitis B virus DNA level, which demonstrated a nonlinear parabolic association in both cohorts, with the highest risk seen for moderate viral loads.

Age, sex, platelet count, ALT levels, and positive hepatitis B e antigen result were additional predictors included in the new model. Satisfactory discrimination and calibration were exhibited by the model, with c-statistics of 0.844 and 0.813 in the derivation and validation cohorts, respectively, with multiple imputation. Greater positive net benefit was yielded in the model compared with other strategies at the 0 to 18 percent threshold.

“This model has the potential to inform optimal medical management strategies for patients with CHB who do not meet the current criteria for antiviral treatment,” the authors write.

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