A novel predictive score for hepatocellular carcinoma development in patients with chronic hepatitis C after sustained response to pegylated interferon and ribavirin combination therapy

Abstract

Antiviral therapy can prevent the development of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. However, HCC still develops in patients achieving sustained virological response (SVR). We proposed to evaluate the risk factors and derive a novel risk score for HCC (score_HCC) by summation of products of clinical weights based on the regression coefficients in the final proportional hazards model. From March 2002 to October 2009, we enrolled 871 patients with biopsy-proven CHC, who received combined pegylated interferon and ribavirin therapy and achieved SVR. Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95% CI 1.74–8.37, P = 0.001], high α-fetoprotein levels (HR 3.15, 95% CI 1.60–6.19, P = 0.001), low platelet counts (HR 2.81, 95% CI 1.22–6.44, P = 0.015) and high fibrotic stage (HR 3.95, 95% CI 1.46–10.70, P = 0.007) were independent risk factors. The cut-off level of risk scores was a derived value of 10 and was able to predict the HCC risk with 89.2% sensitivity and 69.5% specificity. The AUC value for the prediction was 0.848. The score_HCC values were further categorized into three risk groups: low risk (score_HCC ≤10), intermediate risk (score_HCC 11–15) and high risk (score_HCC ≥16). The proportion of HCC development increased from 1.37% (9/657) in the low-risk group to 9.14% (16/175) in the intermediate-risk group and 30.77% (12/39) in the high-risk group (P < 0.001). With the novel risk scores, we can estimate the chance of HCC development more exactly and practically. This approach can be used for HCC screening in CHC patients achieving SVR.