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

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. 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. Cox regression analysis showed that old age [hazard ratio (HR) 3.82, 95 CI 1.748.37, P0.001], high -fetoprotein levels (HR 3.15, 95 CI 1.606.19, P0.001), low platelet counts (HR 2.81, 95 CI 1.226.44, P0.015) and high fibrotic stage (HR 3.95, 95 CI 1.4610.70, P0.007) 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 score(HCC) values were further categorized into three risk groups: low risk (score(HCC) 10), intermediate risk (score(HCC) 1115) and high risk (score(HCC) epsilon 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 (P0.001). 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.