aMAP风险评分可预测慢性肝炎患者的肝细胞癌发展

StephenW

aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis

    Rong Fan †
    George Papatheodoridis †
    Jian Sun †
    Philip J. Johnson
    Pietro Lampertico
    Jinlin Hou
  
Open AccessPublished:July 20, 2020DOI:https://doi.org/10.1016/j.jhep.2020.07.025
Highlights

    •
    In total, 17,374 patients with viral and non-viral hepatitis from 11 global prospective cohorts/trials were studied.
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    An HCC risk score (called the aMAP score, ranging from 0 to 100), which involves only age, male, albumin–bilirubin and platelet data, was developed and validated.
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    The aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk irrespective of aetiology and ethnicity.
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    Patients with aMAP score <50, accounting for 44% of overall population, had an HCC incidence of <0.2% per year.

Background & Aims
Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for patients with chronic hepatitis.
Methods
A total of 17,374 patients, comprising 10,578 treated Asian patients with chronic hepatitis B (CHB), 2,510 treated Caucasian patients with CHB, 3,566 treated patients with hepatitis C virus (including 2,489 patients with cirrhosis achieving a sustained virological response) and 720 patients with non-viral hepatitis (NVH) from 11 international prospective observational cohorts or randomised controlled trials, were divided into a training cohort (3,688 Asian patients with CHB) and 9 validation cohorts with different aetiologies and ethnicities (n = 13,686).
Results
We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only age, male, albumin–bilirubin and platelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies, but also in those with different ethnicities (C-index: 0.82–0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0–0.8%, 1.5–4.8%, and 8.1–19.9% in the low- (n = 7,413, 43.6%), medium- (n = 6,529, 38.4%), and high-risk (n = 3,044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7–100% and a negative predictive value of 99.3–100%. The cut-off value of 60 resulted in a specificity of 56.6–95.8% and a positive predictive value of 6.6–15.7%.
Conclusions
This objective, simple, reliable risk score based on 5 common parameters accurately predicted HCC development, regardless of aetiology and ethnicity, which could help to establish a risk score-guided HCC surveillance strategy worldwide.
Lay summary
In this international collaboration, we developed and externally validated a simple, objective and accurate prognostic tool (called the aMAP score), that involves only age, male, albumin–bilirubin and platelets. The aMAP score (ranged from 0 to 100) satisfactorily predicted the risk of hepatocellular carcinoma (HCC) development among over 17,000 patients with viral and non-viral hepatitis from 11 global prospective studies. Our findings show that the aMAP score had excellent discrimination and calibration in assessing the 5-year HCC risk among all the cohorts irrespective of aetiology and ethnicity.

StephenW

aMAP风险评分可预测慢性肝炎患者的肝细胞癌发展

    荣凡†
    乔治·帕帕特奥多里迪斯†
    孙健†
    菲利普·约翰逊
    Pietro Lampertico
    侯金林
  
开放获取发布时间：2020年7月20日DOI：https：//doi.org/10.1016/j.jhep.2020.07.025
强调

    •
    总共研究了11项全球前瞻性队列/试验中的17374例病毒性和非病毒性肝炎患者。
    •
    制定并验证了仅涉及年龄，男性，白蛋白-胆红素和血小板数据的HCC风险评分（称为aMAP评分，范围从0到100）。
    •
    在评估5年HCC风险时，无论病因和种族如何，aMAP评分均具有出色的判别和校准能力。
    •
    aMAP得分<50的患者，占总人口的44％，每年的HCC发生率<0.2％。

背景与目标
肝细胞癌（HCC）是慢性肝炎患者的主要死亡原因。在这项国际合作中，我们寻求建立全球通用的HCC风险评分，以预测慢性肝炎患者的HCC发生情况。
方法
总计17,374名患者，其中包括10,578名接受治疗的亚洲慢性乙型肝炎（CHB）患者，2,510名接受治疗的白种人CHB患者，3,566例接受治疗的丙型肝炎患者（包括2,489例获得持续病毒学应答的肝硬化患者）和720例非慢性乙型肝炎患者。来自11个国际前瞻性观察性队列研究或随机对照试验的-病毒性肝炎（NVH）分为训练队列（3688例CHB亚洲患者）和9个病因和种族不同的验证队列（n = 13686）。
结果
我们制定了HCC风险评分，称为aMAP评分（范围从0到100），仅涉及年龄，男性，白蛋白-胆红素和血小板。该指标不仅在不同病因的肝炎患者中，而且在不同种族的肝炎患者中，在评估HCC风险方面也表现出色（C指数：0.82-0.87）。区分HCC风险的最佳临界值为50和60。低（n = 7,413，43.6％），中（n = 6,529，38.4％）的3年或5年HCC累积发生率分别为0-0.8％，1.5-4.8％和8.1-19.9％。 ，高风险（n = 3,044，17.9％）组。临界值50与灵敏度85.7–100％和负预测值99.3–100％相关。临界值为60，特异性为56.6–95.8％，阳性预测值为6.6–15.7％。
结论
该客观，简单，可靠的风险评分基于5个常见参数，可准确预测HCC的发生，而不论病因和种族如何，这可能有助于在全球范围内建立以风险评分为指导的HCC监测策略。
放置摘要
在这项国际合作中，我们开发并外部验证了一种简单，客观，准确的预后工具（称为aMAP评分），该工具仅涉及年龄，男性，白蛋白-胆红素和血小板。来自11项全球前瞻性研究的aMAP评分（介于0到100之间）令人满意地预测了超过17,000例病毒性和非病毒性肝炎患者的肝细胞癌（HCC）发生风险。我们的研究结果表明，aMAP评分在评估所有队列中的5年HCC风险方面具有出色的判别力和校准能力，而不论病因和种族。

StephenW

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