P61 aMAP scores at 3-years preceding hepatocellular carcinoma (HCC) diagnosis are higher in patients with steatotic liver disease compared to chronic viral hepatitis in a Southwest UK population

<h3>Background</h3> The aMAP score (based on age, sex, albumin, bilirubin, and platelets), risk stratifies patients into low (0–49.9), medium (50–59.9) or high-risk (≥60) of developing hepatocellular carcinoma (HCC) over 5 years. It was primarily developed in patients with viral hepatitis with steatotic liver disease (SLD) largely under-represented in its validation; we aimed to evaluate its utility in our regional Southwest UK population. <h3>Methods</h3> Retrospective review of the aMAP scores of patients diagnosed with HCC in the Bristol regional HPB MDT between June 2020-July 2023, and 3 and 5-years preceding diagnosis. Comparison was made between patients with SLD and chronic viral hepatitis using the Chi-square statistic (Chi2); patients with medium and low-risk scores were compared to those with a high-risk score. <h3>Results</h3> 134 patients (114 males; 85%; median age 70 years (IQR 13)) diagnosed with HCC at the regional HPB MDT. 73 patients (54%) had underlying SLD (33 ARLD; 35 MASLD; 5 MetALD) and 27 (20%) with chronic hepatitis B (HBV; n=4) or C (HCV; n=23). At HCC diagnosis, 75% (n=101) had a high-risk aMAP score (median 64, (IQR 9)). 28 (21%) and 5 (4%) patients had medium-risk and low-risk scores respectively. Of the low-risk scores, 4 were female. 73 patients (median 63, (IQR 8)) had 3-year historic aMAP scores; 40 (55%) had underlying SLD and 14 (19%) chronic viral hepatitis. 75% (n=55) had high-risk and 25% (n=18) medium-risk scores. 57 patients (median 61, (IQR 8)) had 5-year historic aMAP scores with 67% (n=38) high-risk; 28 patients (49%) had underlying SLD and 13 (23%) chronic viral hepatitis. Only 1 patient (female, HCV) had a low risk aMAP score. Differences between aetiology of liver disease and aMAP scores were evaluated; SLD was associated with a higher median aMAP score (66) at HCC diagnosis compared to patients with chronic viral hepatitis (median aMAP score 66 vs 61; p=0.003, Chi2 8.475) and at 3-years preceding HCC diagnosis (median aMAP score 65 v 61; p=0.015, Chi2 5.89) respectively. There was no association at 5-years preceding HCC diagnosis (median aMAP score 63 v 60; p=0.176, Chi2 1.83) between patients with SLD and chronic viral hepatitis. <h3>Conclusion</h3> Patients with SLD had a higher median aMAP score at diagnosis and 3-years preceding HCC diagnosis compared to patients with chronic viral hepatitis. Our data adds to the growing evidence of the appropriate use of aMAP in a western population, where patients with SLD predominates to help in HCC risk-stratification. <h3>References</h3> Burke, <i>et al</i>. Hepatocellular carcinoma risk scores for non-viral liver disease: a systematic review and meta-analysis. <i>J Hepatol</i>. 2024;7(1):101227.doi:10.1016/j.jhepr.2024.101227 European Association for the Study of the Liver EASL Policy Statement: risk-based surveillance for hepatocellular carcinoma among patients with cirrhosis. 2023. 2023. Available at: https://easl.eu/publication/easl-policy-statement-risk-based Fan, <i>et al</i>. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis. <i>J Hepatol</i>. 2020;73(6):1368–1378. doi:10.1016/j.jhep.2020.07.025