Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B.
OBJECTIVE
To determine whether gender, age, hepatitis B virus genotype, core promoter and precore mutations, HBeAg/ anti-HBe status, HBV DNA, ALT levels and cirrhosis on presentation were independent risk factors and derive a novel risk score for the development of HCC.


METHODS
CHB patients (820) were followed up (mean duration 76.8 months) for the occurrence of HCC.


RESULTS
The 5- and 10-year prevalence of HCC were 4.4% and 6.3%, respectively. Cox regression analysis showed that male gender (p = 0.025, RR 2.98), increasing age (p < 0.001, RR 1.07), higher HBV DNA levels (p = 0.02, RR 1.28), core promoter mutations (p = 0.007, RR 3.66), and presence of cirrhosis (p < 0.001, RR 7.31) were independent risks for the development of HCC. A risk score was derived and validated with sensitivity > 84% and specificity > 76% to predict the 5- and 10- year risks for the development of HCC. The AUC for the 5- and 10-year prediction were 0.88 and 0.89, respectively.


CONCLUSIONS
The risk score, based on age, gender, HBV DNA levels, core promoter mutations and cirrhosis, can estimate the chance of development of HCC in 5 and 10 years after presentation. It can be used to identify high-risk CHB patients for treatment and screening of HCC.
Yuen
Man-Fung
MF
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. mfyuen@hkucc.hku.hk
Tanaka
Yasuhito
Y
Fong
Daniel Yee-Tak
DY
Fung
James
J
Wong
Danny Ka-Ho
DK
Yuen
John Chi-Hang
JC
But
David Yiu-Kuen
DY
Chan
Annie On-On
AO
Wong
Benjamin Chun-Yu
BC
Mizokami
Masashi
M
Lai
Ching-Lung
CL
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D014758:Viral Core Proteins / Q000235:genetics; D055815:Young Adult
D004279:DNA, Viral; D014758:Viral Core Proteins