Independent risk factors and predictive score for the development of hepatocellular carcinoma in chronic hepatitis B

J Hepatol. 2009 Jan;50(1):80-8. doi: 10.1016/j.jhep.2008.07.023. Epub 2008 Sep 21.

Abstract

Background/aims: 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.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / diagnosis
  • Carcinoma, Hepatocellular / epidemiology*
  • DNA, Viral / blood
  • Female
  • Genotype
  • Hepatitis B virus / genetics
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / genetics
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis
  • Liver Neoplasms / diagnosis
  • Liver Neoplasms / epidemiology*
  • Longitudinal Studies
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Mutation / genetics
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Risk Factors
  • Sex Factors
  • Viral Core Proteins / genetics
  • Young Adult

Substances

  • DNA, Viral
  • Viral Core Proteins