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GES: A validated simple score to predict the risk of HCC in patients with HCV‐GT4‐associated advanced liver fibrosis after oral antivirals
Author(s) -
Shiha Gamal,
Waked Imam,
Soliman Reham,
Elbasiony Mohamed,
Gomaa Asmaa,
Mikhail Nabiel N. H.,
Eslam Mohammed
Publication year - 2020
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14666
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , framingham risk score , proportional hazards model , cohort , hepatitis c , oncology , hepatitis c virus , cumulative incidence , gastroenterology , immunology , disease , virus
Background & Aims Hepatocellular carcinoma (HCC) risk persists after hepatitis C virus (HCV) eradication with direct‐acting antivirals (DAAs), particularly in patients with cirrhosis. Identifying those who are likely to develop HCC is a critical unmet medical need. Our aim is to develop a score that offers individualized patient HCC risk prediction. Methods This two‐centre prospective study included 4400 patients, with cirrhosis and advanced fibrosis who achieved a sustained virologic response (SVR), including 2372 patients (derivation cohort). HCC‐associated factors were identified by multivariable Cox regression analysis to develop a scoring model for prediction of HCC risk; and subsequently internally and externally validated in two independent cohorts of 687 and 1341 patients. Results In the derivation cohort, the median follow‐up was 23.51 ± 8.21 months, during which 109 patients (4.7%) developed HCC. Age, sex, serum albumin, α fetoprotein and pretreatment fibrosis stage were identified as risk factors for HCC. A simple predictive model (GES) score was constructed. The 2‐year cumulative HCC incidence using Kaplan‐Meier method was 1.2%, 3.3% and 7.1% in the low‐risk, medium‐risk and high‐risk groups respectively. Internal and external validation showed highly significant difference among the three risk groups ( P < .001) with regard to cumulative HCC risk. GES score has high predictive ability value (Harrell's C statistic 0.801), that remained robustly consistent across two independent validation cohorts (Harrell's C statistic 0.812 and 0.816). Conclusion GES score is simple with validated good predictive ability for the development of HCC after eradication of HCV and may be useful for HCC risk stratification in those patients.