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Risk model predicts HCC progression in HBV-related cirrhosis

Researchers developed an effective risk model for measuring long-term outcomes of nodules with undetermined malignant potential and hepatocellular carcinoma progression in patients with hepatitis B virus-related cirrhosis, per published findings in the American Journal of Gastroenterology.

Hyo Jung Cho, MD, PhD, department of gastroenterology, Ajou University School of Medicine, South Korea, and colleagues used computed tomography to measure 494 indeterminate nodules up to 2 cm in 474 patients enrolled at Ajou University Hospital between January 2005 and December 2013.

“In clinical practice, imaging interpretation and management decision for these nodules are difficult because accurate diagnosis and estimation of their malignant potential is difficult, particularly in nodules [less than] 2 cm. Intermediate nodules … should be differentially diagnosed with regenerative nodule, dysplastic nodule, early HCC and ‘non-nodule–nodule-like lesions’. ... Reliable and easy-to-use clinical models for predicting long-term outcome of the indeterminate nodules would be helpful in clinical practice,” Cho and colleagues wrote. 

The researchers identified independent risk factors for HCC progression via Kaplan-Meier and Cox regression analyses: old age, arterial enhancement, large nodule size, low serum albumin level, high serum alpha-fetoprotein (AFP) level and prior HCC history.

In patients with chronic HBV, old age (HR = 1.06; 95% CI, 1.04-1.09), arterial enhancement (HR = 2.62; 95% CI, 1.33-5.18), nodule size larger than 1 cm (HR = 7.34; 95% CI, 3.7-13.57), serum albumin levels at or below 3.5 g/dL (HR = 3.57; 95% CI, 1.72-7.42), serum AFP level at or greater than 100 ng/mL (HR = 6.04; 95% CI, 1.69-21.56), prior HCC history (HR = 4.24; 95% CI, 1.76-10.19) and baseline hepatitis B e antigen positivity (HR = 2.31; 95% CI, 1.26-4.24) were associated with HCC progression in indeterminate nodules.

Using these risk factors, the researchers developed a risk prediction model and identified patients at low, intermediate and high risk for HCC. The 5-year cumulative incidences were 1% for low, 14.5% for intermediate and 63.1% for high risk. The model showed good performance with area under the receiving curves of 0.879 at 3 years and 0.922 at 5 years in a derivation cohort, and 0.886 at 3 years and 0.92 at 5 years in a leave-one-out cross-validation.

“This model could be helpful in clinical decision in cirrhosis-associated indeterminate nodules and, finally, it could provide comprehensive and individualized medicine for each patient with HBV-related cirrhosis,” the researchers concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.