title: Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B.
abstract: 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.
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. mfyuen@hkucc.hku.hk
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Daniel Yee-Tak
authors.initials: DY
authors.lastname: Fong
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.forename: Danny Ka-Ho
authors.initials: DK
authors.lastname: Wong
authors.forename: John Chi-Hang
authors.initials: JC
authors.lastname: Yuen
authors.forename: David Yiu-Kuen
authors.initials: DY
authors.lastname: But
authors.forename: Annie On-On
authors.initials: AO
authors.lastname: Chan
authors.forename: Benjamin Chun-Yu
authors.initials: BC
authors.lastname: Wong
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
mesh_terms: 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
chemical_list: D004279:DNA, Viral; D014758:Viral Core Proteins