Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify,British Journal of Cancer

当前位置： X-MOL 学术 › Br. J. Cancer › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Evaluation of the aMAP score for hepatocellular carcinoma surveillance: a realistic opportunity to risk stratify
British Journal of Cancer ( IF 6.4 ) Pub Date : 2022-07-07 , DOI: 10.1038/s41416-022-01851-1
Philip J Johnson ₁ , Hamish Innes _{2,

3,

4} , David M Hughes ₅ , Anton Kalyuzhnyy ₆ , Takashi Kumada ₇ , Hidenori Toyoda ₈

Affiliation

Background and aims

The aMAP score is a model that predicts risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis. Its performance in a ‘real world’ surveillance setting has not yet been ascertained.

Patients and methods

We had access to a cohort of 3473 individuals enrolled in a rigorously implemented and prospectively accrued surveillance programme (patients undergoing regular ultrasound and biomarker examination between 1998 and 2021). During this period 445 had HCC detected. Of these, 77.8% had early stage disease (within Milan criteria), permitting potentially curative therapy to be implemented in nearly 70% of cases. We applied the recently developed aMAP score to classify patients according to their initial aMAP score in to low, medium and high-risk groups as proposed in the original publication. The performance of the aMAP score was assessed according to the concordance-index and calibration (i.e. agreement between observed and predicted risk). Allowance was made for competing causes of death.

Results

The aMAP score achieved an overall C-index of 0.81 (95% CI: 0.79–0.82) consistent with the initial report and was unaffected by allowance for competing causes of death. Sub-group analysis showed that the results did not change significantly according to gender, or aetiology. However, aMAP discrimination was greater for younger individuals (versus older individuals), and also for individuals without cirrhosis. The HCC incidence rate was 0.98, 7.05 and 29.1 events per 1000 person-years in the low-, moderate- and high-risk aMAP groups, respectively.

Conclusions

The results from this ‘real-world’ cohort demonstrate that risk stratification is a realistic prospect and that identification of a subgroup of chronic liver disease patients who have a very low risk of HCC is feasible.

中文翻译：

肝细胞癌监测的 aMAP 评分评估：风险分层的现实机会

背景和目标

aMAP 评分是一种预测慢性肝炎患者发生肝细胞癌 (HCC) 风险的模型。它在“现实世界”监视环境中的性能尚未确定。

患者和方法

我们访问了一个由 3473 人组成的队列，这些人参加了严格实施和前瞻性累积的监测计划（1998 年至 2021 年间接受定期超声和生物标志物检查的患者）。在此期间，有 445 人检测到 HCC。其中，77.8% 患有早期疾病（在米兰标准内），允许对近 70% 的病例实施潜在的治愈性治疗。我们应用最近开发的 aMAP 评分，根据原始出版物中提出的初始 aMAP 评分将患者分为低、中和高风险组。aMAP 评分的性能根据一致性指数和校准（即观察到的风险和预测的风险之间的一致性）进行评估。考虑到竞争性死因。

结果

aMAP 评分的总体C指数为 0.81（95% CI：0.79–0.82），与初始报告一致，并且不受考虑竞争死因的影响。亚组分析表明，结果没有根据性别或病因发生显着变化。然而，aMAP 对年轻人（相对于老年人）以及没有肝硬化的人的歧视更大。在低风险、中风险和高风险 aMAP 组中，HCC 发病率分别为每 1000 人年 0.98、7.05 和 29.1 起事件。