Simple score to predict risk of hepatocellular carcinoma in chronic hepatitis C patients with advanced fibrosis after pegylated interferon and ribavirin therapy

Figures & data

Figure 1 Diagram of the study design and diagnosis.

Abbreviation: HCV, hepatitis C virus.

Table 1 Baseline clinical and virologic characteristics of advanced fibrotic chronic hepatitis C patients with and without HCC

Parameter	All (n=271)	Non-HCC (n=211)	HCC (n=60)	P-value
Age (years)a	57.5±10.3	56.2±10.4	62.0±8.5	<0.001***
Gender (male)b	128 (47.2)	97 (46.0)	31 (51.7)	0.436
Body mass index (kg/m^2)a	25.6±3.5	25.5±3.6	26.1±3.1	0.263
Albumin (g/dL)a	4.1±0.3	4.2±0.3	4.0±0.4	0.001**
AST (U/L)a	93.0±51.1	90.1±50.4	105.4±52.8	0.068
ALT (U/L)a	124.0±87.5	124.8±91.4	121.0±70.8	0.788
AST/ALT ratioa	0.83±0.28	0.81±0.28	0.92±0.27	0.016*
Total bilirubin (mg/dL)a	1.0±0.36	1.0±0.3	1.2±0.4	0.001**
White blood cells (×10^3/μL)a	5.6±1.8	5.7±1.8	5.4±1.7	0.227
Hemoglobin level (g/dL)a	14.1±1.7	14.1±1.7	14.1±1.7	0.891
Platelet count (×10^3/μL)a	144.0±54.3	149.3±54.4	122.7±49.0	0.002**
AFP (ng/mL)a	39.6±251.3	18.2±30.7	120.4±541.4	0.007**
HCV RNA (×10^6 IU/mL)a	7.38±12.86	7.44±12.00	7.16±15.63	0.890
HCV Genotype 1bb	158/260 (60.8)	123/203 (60.6)	35/57 (59.9)	0.912
RVRb	108/200 (54.0)	87/157 (55.4)	21/73 (48.8)	0.443
SVRb	156 (57.6)	133 (63.0)	23 (38.3)	0.001**
PegIFN 2ab	178 (65.7)	143 (68.7)	35 (58.3)	0.174
PegIFN (48 weeks)b	40 (14.8)	34 (16.1)	6 (10.0)	0.239
Cirrhosisb	189 (69.7)	138 (65.4)	51 (85.0)	0.004**
Fatty liverb	80 (29.5)	71 (33.6)	9 (15.0)	0.005**
DMb	62 (22.9)	54 (25.6)	8 (13.3)	0.046*

Notes:

* P<0.05;

** P<0.01;

*** P<0.001;

a mean±standard deviation;

b no (%)

Abbreviations: AFP, α-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; DM, diabetes mellitus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; pegIFN, pegylated interferon; RVR, rapid virologic response; SVR, sustained virologic response.

Table 2 Analysis of predictors of HCC using univariate and multivariate Cox regression models

	B	SE	HR (95% CI)	P-value
Univariate
Age (years)	0.051	0.14	1.025 (1.023–1.082)	<0.001***
Gender (M vs F)	0.297	0.258	1.346 (0.811–2.235)	0.250
Body mass index (kg/m^2)	0.030	0.038	1.031 (0.957–1.110)	0.421
Albumin (g/dL)	−1.154	0.347	0.315 (0.160–0.623)	0.001**
AST (U/L)	0.004	0.002	1.004 (1.000–1.009)	0.078
ALT (U/L)	−0.001	0.002	0.999 (0.996–1.003)	0.688
AST/ALT ratio	0.985	0.383	2.446 (1.156–5.179)	0.019
Total bilirubin (mg/dL)	0.855	0.294	2.351 (1.321–4.185)	0.004**
White blood cells (×10^3/μL)	−0.095	0.084	0.909 (0.770–1.073)	0.259
Hemoglobin level (g/dL)	0.011	0.085	1.011 (0.856–1.194)	0.900
Platelet count (×10^3/μL)	−0.010	0.003	0.990 (0.984–0.996)	0.001**
AFP (ng/mL)	0.001	0.000	1.001 (1.000–1.001)	0.003**
HCV RNA (IU/mL)	0.015	0.011	1.015 (0.993–1.038)	0.180
Genotype (1b vs non-1b)	0.033	0.272	1.033 (0.606–1.762)	0.904
nRVR (yes vs no)	0.426	0.307	1.530 (0.838–2.794)	0.166
nSVR (yes vs no)	0.901	0.267	2.461 (1.459–4.151)	0.001**
pegIFN (2a vs 2b)	−0.404	0.263	0.667 (0.399–1.117)	0.124
pegIFN (48 vs 24 wk)	0.287	0.443	1.333 (0.560–3.174)	0.516
Cirrhosis (yes vs no)	1.316	0.364	3.728 (1.828–7.605)	<0.001***
Fatty liver (yes vs no)	−1.106	0.362	0.331 (0.163–0.673)	0.002**
DM (no vs yes)	0.861	0.380	2.365 (1.123–4.983)	0.024*
Multivariate
Age ≥59.5 vs <59.5 (years)	0.933	0.308	2.542 (1.390–4.650)	0.002**
Total bilirubin ≥1.1 vs <1.1 (mg/dL)	0.967	0.314	2.630 (1.420–4.871)	0.002**
nSVR (yes vs no)	0.846	0.307	2.331 (1.277–4.253)	0.006**
Platelet count <146.5 vs ≧146.5 (×10^3/μL)	1.012	0.355	2.751 (1.373–5.511)	0.004**
DM (no vs yes)	1.127	0.448	3.085 (1.283–7.418)	0.012*

Notes:

* P<0.05;

** P<0.01;

*** P<0.001.

Abbreviations: AFP, α-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CI, confidence interval; DM, diabetes mellitus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HR, hazard ratio; nSVR, no sustained virologic response; nRVR, no rapid virologic response; pegIFN, pegylated interferon; wk, week.

Figure 2 Area under receiver operating curve (AUROC) analysis of the simple score to predict the occurrence of hepatocellular carcinoma.

Abbreviation: AUC, area under curve.

Figure 3 Cumulative incidence rate of hepatocellular carcinoma.

Abbreviation: HCC, hepatocellular carcinoma.

Table 3 Prediction of hepatocellular carcinoma using the new score

Predictive factor	Cutoff point	Youden index	Sensitivity %	Specificity %	Overall correctness %
New score	2.5	0.388	81.3	57.5	62.2