Jian Xing1, Philip R Spradling2, Anne C Moorman1, Scott D Holmberg1, Eyasu H Teshale1, Loralee B Rupp3, Stuart C Gordon3, Mei Lu3, Joseph A Boscarino4, Mark A Schmidt5, Connie M Trinacty6, Fujie Xu1. 1. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Mailstop G37, 1600 Clifton Road NE, Atlanta, GA, 30333, USA. 2. Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Mailstop G37, 1600 Clifton Road NE, Atlanta, GA, 30333, USA. pspradling@cdc.gov. 3. Henry Ford Health System, Detroit, MI, USA. 4. Center for Health Research, Geisinger Health System, Danville, PA, USA. 5. The Center for Health Research, Kaiser Permanente-Northwest, Portland, OR, USA. 6. The Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, HI, USA.
Abstract
BACKGROUND: Risk of hepatocellular carcinoma (HCC) may be difficult to determine in the clinical setting. AIM: Develop a scoring system to forecast HCC risk among patients with chronic hepatitis C. METHODS: Using data from the Chronic Hepatitis Cohort Study collected during 2005-2014, we derived HCC risk scores for males and females using an extended Cox model with aspartate aminotransferase-to-platelet ratio index (APRI) as a time-dependent variables and mean Kaplan-Meier survival functions from patient data at two study sites, and used data collected at two separate sites for external validation. For model calibration, we used the Greenwood-Nam-D'Agostino goodness-of-fit statistic to examine differences between predicted and observed risk. RESULTS: Of 12,469 patients (1628 with a history of sustained viral response [SVR]), 504 developed HCC; median follow-up was 6 years. Final predictors in the model included age, alcohol abuse, interferon-based treatment response, and APRI. Point values, ranging from -3 to 14 (males) and -3 to 12 (females), were established using hazard ratios of the predictors aligned with 1-, 3-, and 5-year Kaplan-Meier survival probabilities of HCC. Discriminatory capacity was high (c-index 0.82 males and 0.84 females) and external calibration demonstrated no differences between predicted and observed HCC risk for 1-, 3-, and 5-year forecasts among males (all p values >0.97) and for 3- and 5-year risk among females (all p values >0.87). CONCLUSION: This scoring system, based on age, alcohol abuse history, treatment response, and APRI, can be used to forecast up to a 5-year risk of HCC among hepatitis C patients before and after SVR.
BACKGROUND: Risk of hepatocellular carcinoma (HCC) may be difficult to determine in the clinical setting. AIM: Develop a scoring system to forecast HCC risk among patients with chronic hepatitis C. METHODS: Using data from the Chronic Hepatitis Cohort Study collected during 2005-2014, we derived HCC risk scores for males and females using an extended Cox model with aspartate aminotransferase-to-platelet ratio index (APRI) as a time-dependent variables and mean Kaplan-Meier survival functions from patient data at two study sites, and used data collected at two separate sites for external validation. For model calibration, we used the Greenwood-Nam-D'Agostino goodness-of-fit statistic to examine differences between predicted and observed risk. RESULTS: Of 12,469 patients (1628 with a history of sustained viral response [SVR]), 504 developed HCC; median follow-up was 6 years. Final predictors in the model included age, alcohol abuse, interferon-based treatment response, and APRI. Point values, ranging from -3 to 14 (males) and -3 to 12 (females), were established using hazard ratios of the predictors aligned with 1-, 3-, and 5-year Kaplan-Meier survival probabilities of HCC. Discriminatory capacity was high (c-index 0.82 males and 0.84 females) and external calibration demonstrated no differences between predicted and observed HCC risk for 1-, 3-, and 5-year forecasts among males (all p values >0.97) and for 3- and 5-year risk among females (all p values >0.87). CONCLUSION: This scoring system, based on age, alcohol abuse history, treatment response, and APRI, can be used to forecast up to a 5-year risk of HCC among hepatitis C patients before and after SVR.
Authors: Chi-Pang Wen; Jie Lin; Yi Chen Yang; Min Kuang Tsai; Chwen Keng Tsao; Carol Etzel; Maosheng Huang; Chung Yi Hsu; Yuanqing Ye; Lopa Mishra; Ernest Hawk; Xifeng Wu Journal: J Natl Cancer Inst Date: 2012-10-17 Impact factor: 13.506
Authors: Scott D Holmberg; Mei Lu; Loralee B Rupp; Lois E Lamerato; Anne C Moorman; Vinutha Vijayadeva; Joseph A Boscarino; Emily M Henkle; Stuart C Gordon Journal: Clin Infect Dis Date: 2013-04-16 Impact factor: 9.079
Authors: W Ohishi; M Kitamoto; H Aikata; K Kamada; Y Kawakami; H Ishihara; M Kamiyasu; T Nakanishi; S Tazuma; K Chayama Journal: Scand J Gastroenterol Date: 2003-08 Impact factor: 2.423
Authors: Mei Lu; Jia Li; Loralee B Rupp; Scott D Holmberg; Anne C Moorman; Philip R Spradling; Eyasu H Teshale; Yueren Zhou; Joseph A Boscarino; Mark A Schmidt; Lois E Lamerato; Connie Trinacty; Sheri Trudeau; Stuart C Gordon Journal: J Viral Hepat Date: 2016-03-30 Impact factor: 3.728
Authors: Anne C Moorman; Loralee B Rupp; Stuart C Gordon; Yuna Zhong; Jian Xing; Mei Lu; Joseph A Boscarino; Mark A Schmidt; Yihe G Daida; Eyasu H Teshale; Philip R Spradling; Scott D Holmberg Journal: Infect Dis Clin North Am Date: 2018-06 Impact factor: 5.982