Prediction Model for Risk of Hepatocellular Carcinoma After Hepatitis C Viral Eradication

Wei-Fan Hsu,1,2,* Ching-Chu Lo,3,* Kuo-Chih Tseng,4,5,* Hsueh-Chou Lai,1,2 Chi-Yi Chen,6 Cheng-Yuan Peng1,7 1Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 2School of Chinese Medicine, China Medical University, Taichung, Taiwan; 3Department of Internal Medicine, St. Martin De Porres Hospital-Daya, Chiayi, Taiwan; 4Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; 5School of Medicine, Tzuchi University, Hualien, Taiwan; 6Department of Internal Medicine, Chiayi Christian Hospital, Chiayi, Taiwan; 7School of Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Cheng-Yuan Peng, Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan, Tel +886 4 22052121 ext 12260, Fax +886 4 22071600, Email [email protected] Chi-Yi Chen, Department of Internal Medicine, Chiayi Christian Hospital, No. 539, Zhongxiao Road, East District, Chiayi, Taiwan, Tel +886 5 2765041 ext 2535, Fax +886 5 2788421, Email [email protected]: The predictors of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC) and a sustained virologic response after direct-acting antiviral therapy are not well known.Patients and Methods: Between September 2012 and March 2022, this retrospective study enrolled 4426 consecutive patients from 4 hospitals in Taiwan. The patients were divided into derivation (n = 3178) and validation (n = 1248) groups.Results: In the derivation group, age, diabetes mellitus, platelet, albumin, and alpha-fetoprotein at 12 weeks after antiviral therapy were independent predictors of hepatocellular carcinoma. We incorporated these predictors into a novel risk prediction model called the AAAPD-C score (age, albumin, alpha-fetoprotein level, platelet count, and diabetes mellitus status), with total risk scores ranging from 0 to 12. The AAAPD-C score had an area under the receiver operating characteristic curve of 0.867 for the validation group at the end of follow-up. The risk score accurately classified patients in both groups into those with low, medium, and high risks. Patients without advanced liver fibrosis with medium-high AAAPD-C risk scores (4– 12) had an annual incidence of HCC > 4 per 1000 person-years.Conclusion: The AAAPD-C score can predict the risk of HCC in patients with chronic hepatitis C and a sustained virologic response after direct-acting antiviral therapy. The tool is accurate and inexpensive, and clinicians can use it to identify patients with chronic hepatitis C at risk of HCC following viral eradication.Plain Language Summary: AAAPD-C score (age, albumin, AFP level, platelet count, and DM status 12 weeks after antiviral therapy) can predict the risk of hepatocellular carcinoma in patients after hepatitis C viral eradication with direct-acting antivirals. It is an accurate, inexpensive, and convenient tool.Keywords: AAAPD-C score, direct-acting antiviral agent, hepatitis C virus, hepatocellular carcinoma