Recommendations on HCC surveillance in HBV patients by liver associations
| APASL [25] | AASLD [26] | EASL-EORTC [27] | |
|---|---|---|---|
| Population group |
|
|
|
| Modality | US + AFP | US | US |
| Interval | 6-monthly | 6-monthly | 6-monthly |
Risk factors for HBV-related HCC
| GAG-HCC [52] | CU-HCC [53] | REACH-B [54] | PAGE-B [55] | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Patients (n) | 820 | 1,005 | 3,584 | 1,325 | |||||
| Training cohort (TC) | Chinese | Chinese | Chinese | Europeans | |||||
| Patients (n) | Leave one out cross validation | 424 | 1505 | 490 | |||||
| Validation cohort (VC) | Chinese | Chinese and Koreans | Italians | ||||||
| Age (years) | 40.6 | 48.0 | 45.7 | 52 | |||||
| Antiviral therapy (%) | 0 | TC: 15.1 | TC: 0 | TC: 100 | |||||
| VC: 25 | VC: 0 | VC: 100 | |||||||
| Cirrhosis (%) | 15.1 | TC: 38.1 | TC: 0.0 | TC: 20.3 | |||||
| VC: 16.3 | VC: 18.4 | VC: 47.8 | |||||||
| Follow-up (years) | 6.4 | 9.9 | 12.0 | 4.2 | |||||
| HCC (n, %) | 40(4.9) | TC: 105 (10.4) | TC: 131 (3.7) | TC: 51 (3.8) | |||||
| VC: 45 (10.6) | VC: 111(7.4) | VC: 34 (6.9) | |||||||
| Score | Variable | Points | Variable | Points | Variable | Points | Variable | Points | |
| Age | 1 per year | Age >50 years | 3 | Age | 1 per 5 years | Age 16–29 | 0 | ||
| Male | 16(14 Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL. | Albumin ≤3.5g/dL | 20 | over 30 | 30–39 | 2 | |||
| Cirrhosis | 30(33 Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL. | Bilirubin > 1. lmg/dL | 1.5 | Male | 2 | 40–49 | 4 | ||
| HBVDNA | 3 (3 Simplified GAG-HCC score without core promoter mutation. HB V DNA measured in log10 copies/mL. | Cirrhosis | 15 | ALT (U/L) 15–44 | 1 | 50–59 | 6 | ||
| BCP Mutation | 19 | HBVDNA | ≥45 | 2 | 60–69 | 8 | |||
| 4–6 log | 1 | HBeAg positive | 2 | ≥70 | 10 | ||||
| 6 log | 4 | HBVDNA | Male | 6 | |||||
| <41og | 0 | Platelets (/mm3) | |||||||
| 4–<5 log | 3 | ≥200,000 | 0 | ||||||
| 5–<6 log | 5 | 100,000-199,999 | 6 | ||||||
| ≥6 log | 4 | <100,000 | 9 | ||||||
| Optimum cut-offs | With inclusion of BCP Mutation: | Low risk <5 | 17-point risk score | Low risk <10 | |||||
| Intermediate risk 5–20 | Intermediate 10–17 | ||||||||
| Lowrisk<101 | High risk >20 | High risk ≥18 | |||||||
| High risk ≥ 101 | |||||||||
| Without inclusion of BCP mutation: | |||||||||
| 5-year prediction | |||||||||
| Low risk < 100 | |||||||||
| High risk ≥ 101 | |||||||||
| 10-year prediction | |||||||||
| Low risk <82 | |||||||||
| High risk ≥82 | |||||||||
| Performance | Using a cut-off of 101: | Using a cut-off of 5: | AUROC: | Using cut-off of 10: | |||||
| 5-year prediction | 5-year prediction | 3 years 0.811 | Harrell’s c-index 0.82 | ||||||
| AUROC0.88 | AUROC 0.76 | 5 years 0.796 | 5-year prediction | ||||||
| Sensitivity 87.9% | Sensitivity 78.3% | 10 years 0.769 | Sensitivity 100% | ||||||
| Specificity 76.2% | Specificity 72.8% | Specificity 19.6% | |||||||
| PPV 14.6% | PPV 14.2% | PPV 10.3% | |||||||
| NPV 99.3% | NPV 98.3% | NPV 100% | |||||||
| 10-year prediction | 10-year prediction | ||||||||
| AUROC 0.89 | AUROC 0.78 | ||||||||
| Sensitivity 100% | Sensitivity 81.0% | ||||||||
| Specificity 79.1% | Specificity 75.7% | ||||||||
| PPV 25.7% | PPV 26.8% | ||||||||
| NPV 100% | NPV 97.3% | ||||||||