A NEW prognostic model for assessing the risk of hepatocellular carcinoma (HCC) in noncirrhotic patients with chronic hepatitis B (CHB) has been developed and externally validated, incorporating serum hepatitis B virus (HBV) DNA levels alongside other key predictors.
Chronic hepatitis B is a major risk factor for developing hepatocellular carcinoma (HCC), but the ability to predict HCC risk in noncirrhotic patients with normal alanine aminotransferase (ALT) levels remains limited. A multinational cohort study was undertaken to create and validate a new model that would improve prediction and risk stratification for this patient group. The study utilised data from various cohorts, including the REVEAL-HBV and REACH-B models in Taiwan and Korea, alongside the GAG-HCC and CU-HCC models in Hong Kong.
A total of 13,378 participants were included in the analysis. Over median follow-up periods of 10 and 12.2 years for the derivation and validation cohorts, respectively, 902 cases of incident HCC were identified. The study found that the baseline HBV DNA level was one of the strongest predictors of HCC, with a nonlinear parabolic association between viral load and risk. Moderate HBV DNA levels (around 6 log10 IU/mL) were linked to the highest risk of HCC. The model also incorporated other variables such as age, sex, platelet count, ALT levels, and hepatitis B e antigen status. The Revised REACH-B model showed excellent discrimination and calibration with c-statistics of 0.844 and 0.813 in the derivation and validation cohorts. Furthermore, it demonstrated a higher positive net benefit compared to other strategies in certain risk thresholds.
This new prognostic model provides a valuable tool for predicting and stratifying HCC risk in noncirrhotic patients with CHB. Its clinical application could aid in decision-making for patient monitoring and intervention strategies. However, further validation in diverse populations and those receiving antiviral treatment is needed. The model represents a step forward in precision medicine, allowing for more tailored surveillance of patients at risk for HCC.
Imani Katheeja, EMJ
Reference
Kim GA et al. Viral load–based prediction of hepatocellular carcinoma risk in noncirrhotic patients with chronic hepatitis b: a multinational study for the development and external validation of a new prognostic model. Ann Intern Med. 2024;177(10):1308-18.
