A novel predictive score for hepatocellular carcinoma development in patients with chronic hepatitis C after sustained response to pegylated interferon and ribavirin combination therapy

Kuo Chin Chang, Chao Hung Hung, Sheng Nan Lu, Jing Houng Wang, Chuan Mo Lee, Chien Hung Chen, Ming Fang Yen, Sheng Chieh Lin, Yi Hao Yen, Ming Chao Tsai, Po Lin Tseng, Tsung Hui Hu

Research output: Contribution to journalArticle

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Abstract

Objectives: Antiviral therapy can prevent the development of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. However, HCC still develops in patients achieving sustained virological response (SVR). We proposed to evaluate the risk factors and derive a novel risk score for HCC (score. HCC) by summation of products of clinical weights based on the regression coefficients in the final proportional hazards model. Methods: From March 2002 to October 2009, we enrolled 871 patients with biopsy-proven CHC, who received combined pegylated interferon and ribavirin therapy and achieved SVR. Results: Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95% CI 1.74-8.37, P = 0.001], high α-fetoprotein levels (HR 3.15, 95% CI 1.60-6.19, P = 0.001), low platelet counts (HR 2.81, 95% CI 1.22-6.44, P = 0.015) and high fibrotic stage (HR 3.95, 95% CI 1.46-10.70, P = 0.007) were independent risk factors. The cut-off level of risk scores was a derived value of 10 and was able to predict the HCC risk with 89.2% sensitivity and 69.5% specificity. The AUC value for the prediction was 0.848. The scoreHCC values were further categorized into three risk groups: low risk (scoreHCC ≤10), intermediate risk (scoreHCC 11-15) and high risk (scoreHCC ≥16). The proportion of HCC development increased from 1.37% (9/657) in the low-risk group to 9.14% (16/175) in the intermediate-risk group and 30.77% (12/39) in the high-risk group (P <0.001). Conclusions: With the novel risk scores, we can estimate the chance of HCC development more exactly and practically. This approach can be used for HCC screening in CHC patients achieving SVR.

Original languageEnglish
Article numberdks269
Pages (from-to)2766-2772
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume67
Issue number11
DOIs
Publication statusPublished - Nov 2012

Fingerprint

Ribavirin
Chronic Hepatitis C
Interferons
Hepatocellular Carcinoma
Therapeutics
Fetal Proteins
Platelet Count
Proportional Hazards Models
Area Under Curve
Antiviral Agents
Regression Analysis
Biopsy
Weights and Measures
Sensitivity and Specificity

Keywords

  • Hepatitis C
  • Hepatocellular carcinoma
  • Pegylated interferon
  • Ribavirin
  • Risk score
  • Sustained virological response

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

A novel predictive score for hepatocellular carcinoma development in patients with chronic hepatitis C after sustained response to pegylated interferon and ribavirin combination therapy. / Chang, Kuo Chin; Hung, Chao Hung; Lu, Sheng Nan; Wang, Jing Houng; Lee, Chuan Mo; Chen, Chien Hung; Yen, Ming Fang; Lin, Sheng Chieh; Yen, Yi Hao; Tsai, Ming Chao; Tseng, Po Lin; Hu, Tsung Hui.

In: Journal of Antimicrobial Chemotherapy, Vol. 67, No. 11, dks269, 11.2012, p. 2766-2772.

Research output: Contribution to journalArticle

Chang, Kuo Chin ; Hung, Chao Hung ; Lu, Sheng Nan ; Wang, Jing Houng ; Lee, Chuan Mo ; Chen, Chien Hung ; Yen, Ming Fang ; Lin, Sheng Chieh ; Yen, Yi Hao ; Tsai, Ming Chao ; Tseng, Po Lin ; Hu, Tsung Hui. / A novel predictive score for hepatocellular carcinoma development in patients with chronic hepatitis C after sustained response to pegylated interferon and ribavirin combination therapy. In: Journal of Antimicrobial Chemotherapy. 2012 ; Vol. 67, No. 11. pp. 2766-2772.
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abstract = "Objectives: Antiviral therapy can prevent the development of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. However, HCC still develops in patients achieving sustained virological response (SVR). We proposed to evaluate the risk factors and derive a novel risk score for HCC (score. HCC) by summation of products of clinical weights based on the regression coefficients in the final proportional hazards model. Methods: From March 2002 to October 2009, we enrolled 871 patients with biopsy-proven CHC, who received combined pegylated interferon and ribavirin therapy and achieved SVR. Results: Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95{\%} CI 1.74-8.37, P = 0.001], high α-fetoprotein levels (HR 3.15, 95{\%} CI 1.60-6.19, P = 0.001), low platelet counts (HR 2.81, 95{\%} CI 1.22-6.44, P = 0.015) and high fibrotic stage (HR 3.95, 95{\%} CI 1.46-10.70, P = 0.007) were independent risk factors. The cut-off level of risk scores was a derived value of 10 and was able to predict the HCC risk with 89.2{\%} sensitivity and 69.5{\%} specificity. The AUC value for the prediction was 0.848. The scoreHCC values were further categorized into three risk groups: low risk (scoreHCC ≤10), intermediate risk (scoreHCC 11-15) and high risk (scoreHCC ≥16). The proportion of HCC development increased from 1.37{\%} (9/657) in the low-risk group to 9.14{\%} (16/175) in the intermediate-risk group and 30.77{\%} (12/39) in the high-risk group (P <0.001). Conclusions: With the novel risk scores, we can estimate the chance of HCC development more exactly and practically. This approach can be used for HCC screening in CHC patients achieving SVR.",
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author = "Chang, {Kuo Chin} and Hung, {Chao Hung} and Lu, {Sheng Nan} and Wang, {Jing Houng} and Lee, {Chuan Mo} and Chen, {Chien Hung} and Yen, {Ming Fang} and Lin, {Sheng Chieh} and Yen, {Yi Hao} and Tsai, {Ming Chao} and Tseng, {Po Lin} and Hu, {Tsung Hui}",
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AU - Chang, Kuo Chin

AU - Hung, Chao Hung

AU - Lu, Sheng Nan

AU - Wang, Jing Houng

AU - Lee, Chuan Mo

AU - Chen, Chien Hung

AU - Yen, Ming Fang

AU - Lin, Sheng Chieh

AU - Yen, Yi Hao

AU - Tsai, Ming Chao

AU - Tseng, Po Lin

AU - Hu, Tsung Hui

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N2 - Objectives: Antiviral therapy can prevent the development of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. However, HCC still develops in patients achieving sustained virological response (SVR). We proposed to evaluate the risk factors and derive a novel risk score for HCC (score. HCC) by summation of products of clinical weights based on the regression coefficients in the final proportional hazards model. Methods: From March 2002 to October 2009, we enrolled 871 patients with biopsy-proven CHC, who received combined pegylated interferon and ribavirin therapy and achieved SVR. Results: Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95% CI 1.74-8.37, P = 0.001], high α-fetoprotein levels (HR 3.15, 95% CI 1.60-6.19, P = 0.001), low platelet counts (HR 2.81, 95% CI 1.22-6.44, P = 0.015) and high fibrotic stage (HR 3.95, 95% CI 1.46-10.70, P = 0.007) were independent risk factors. The cut-off level of risk scores was a derived value of 10 and was able to predict the HCC risk with 89.2% sensitivity and 69.5% specificity. The AUC value for the prediction was 0.848. The scoreHCC values were further categorized into three risk groups: low risk (scoreHCC ≤10), intermediate risk (scoreHCC 11-15) and high risk (scoreHCC ≥16). The proportion of HCC development increased from 1.37% (9/657) in the low-risk group to 9.14% (16/175) in the intermediate-risk group and 30.77% (12/39) in the high-risk group (P <0.001). Conclusions: With the novel risk scores, we can estimate the chance of HCC development more exactly and practically. This approach can be used for HCC screening in CHC patients achieving SVR.

AB - Objectives: Antiviral therapy can prevent the development of hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients. However, HCC still develops in patients achieving sustained virological response (SVR). We proposed to evaluate the risk factors and derive a novel risk score for HCC (score. HCC) by summation of products of clinical weights based on the regression coefficients in the final proportional hazards model. Methods: From March 2002 to October 2009, we enrolled 871 patients with biopsy-proven CHC, who received combined pegylated interferon and ribavirin therapy and achieved SVR. Results: Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95% CI 1.74-8.37, P = 0.001], high α-fetoprotein levels (HR 3.15, 95% CI 1.60-6.19, P = 0.001), low platelet counts (HR 2.81, 95% CI 1.22-6.44, P = 0.015) and high fibrotic stage (HR 3.95, 95% CI 1.46-10.70, P = 0.007) were independent risk factors. The cut-off level of risk scores was a derived value of 10 and was able to predict the HCC risk with 89.2% sensitivity and 69.5% specificity. The AUC value for the prediction was 0.848. The scoreHCC values were further categorized into three risk groups: low risk (scoreHCC ≤10), intermediate risk (scoreHCC 11-15) and high risk (scoreHCC ≥16). The proportion of HCC development increased from 1.37% (9/657) in the low-risk group to 9.14% (16/175) in the intermediate-risk group and 30.77% (12/39) in the high-risk group (P <0.001). Conclusions: With the novel risk scores, we can estimate the chance of HCC development more exactly and practically. This approach can be used for HCC screening in CHC patients achieving SVR.

KW - Hepatitis C

KW - Hepatocellular carcinoma

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KW - Ribavirin

KW - Risk score

KW - Sustained virological response

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