Hepatitis B virus (HBV) infection is an important etiology for hepatocellular carcinoma (HCC). We aim to develop a simple clinical score in predicting the risk of HCC among HBV carriers.
We first evaluated 1,005 patients and found that the following five factors independently predicted HCC development: age, albumin, bilirubin, HBV DNA, and cirrhosis. These variables were used to construct a prediction score ranging from 0 to 44.5. The score was validated in another prospective cohort of 424 patients.
During a median follow-up of 10 years, 105 patients (10.%) in the training cohort and 45 patients (10.6%) in the validation cohort developed HCC. Cutoff values of 5 and 20 best discriminated HCC risk. By applying the cutoff value of 5, the score excluded future HCC development with high accuracy (negative predictive value = 97.8% and 97.3% in the training and validation cohorts, respectively). In the validation cohort, the 5-year HCC-free survival rates were 98.3%, 90.5%, and 78.9% in the low-, medium-, and high-risk groups, respectively. The hazard ratios for HCC in the medium- and high-risk groups were 12.8 and 14.6, respectively.
A simple prediction score constructed from routine clinical and laboratory parameters is accurate in predicting HCC development in HBV carriers. Future prospective validation is warranted.
"For example, Yang et al.  derived a nomogram (from a study with more than 3,600 patients) using parameters of sex, age, family history of HCC, alcohol consumption habit, serum ALT level, HBeAg status, serum HBV DNA level, and HBV genotype to predict the risk of development of HCC at 5 and 10 years. Wong et al.  evaluated more than 1,000 patients and determined five clinical parameters that independently predicted HCC development: age, albumin, bilirubin, HBV DNA, and the presence of cirrhosis. A prediction scoring system was formulated and validated with another cohort with high accuracy and predictability. "
[Show abstract][Hide abstract] ABSTRACT: Chronic hepatitis B virus infection is an important cause of liver-related morbidity and mortality, with hepatocellular carcinoma being the most life-threatening complication. Because of the highly variable clinical course of the disease, enormous research efforts have been made with the aim of revealing the factors in the natural history that are relevant to hepatocarcinogenesis. These include epidemiological studies of predisposing risk groups, viral studies of mutations within the hepatitis B viral genome, and clinical correlation of these risk factors in predicting the likelihood of development of hepatocellular cancer in susceptible hosts. This update addresses these risks, with emphasis on the latest research relevant to hepatocarcinogenesis.
Current Hepatitis Reports 06/2011; 10(2):106-111. DOI:10.1007/s11901-011-0094-2
"Risk factors that have been shown to independently predict the development of HCC in HBV-infected individuals include male gender (relative risk [RR] 2.98), increasing age (RR 1.07), high HBV DNA levels (RR 1.28), core promoter mutations (RR 3.66), and cirrhosis (RR 7.31) . Combining these risk factors with clinical parameters such as albumin and bilirubin, score systems have been created to predict the occurrence of HCC with high accuracy  Thanks to these prediction systems, HBV-infected individuals who will eventually develop HCC might be early identified. Antiviral treatments for these high-risk individuals might reduce or postpone the occurrence of HCC, while frequent examinations may increase early diagnosis and early treatment options. "
[Show abstract][Hide abstract] ABSTRACT: Chronic infection with hepatitis B virus (HBV) is the major risk factor for hepatocellular carcinoma (HCC) worldwide. Ten HBV genotypes (A-J) have been discovered so far. Genotypes B and C are endemic in East and Southeast Asia. Genotype C HBV is associated with increased risks of cirrhosis and HCC. Genotype B (B2) is associated with the development of HCC in non-cirrhotic patients younger than 50 years and with relapse of HCC after surgical treatment. It is also associated with earlier hepatitis B e antigen seroconversion than genotype C. High HBV load is independently associated with the occurrence and post-treatment recurrence of HCC. Different genotypes have distinct patterns of mutations. Viral mutations in the core promoter region and in the preS region are frequently found to be significantly associated with an increased risk of HCC. These mutations often occur before the onset of HCC and accumulate during the progression of chronic HBV infection. Multiple such mutations are more frequent in patients with HCC and are specific for HCC. HBV subgenotypes, viral mutations, and viral load can be used for the prediction of HCC. Early identification of HBV-infected individuals who will eventually develop HCC will help to develop active prophylactic protocols to reduce or delay the occurrence of HCC.
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