Feasibility of aMAP combined with liver stiffness assessed using transient elastography for prediction of hepatocellular carcinoma development in patients with chronic hepatitis B

초록

Background and aims: The age-male-albumin-bilirubin-platelet (aMAP) score combined with liver stiffness (LS) assessed using transient elastography was recently suggested to be helpful for estimating fibrotic burden in patients with chronic hepatitis B (CHB). We evaluated the performance of the aMAP score combination with LS for predicting HCC development. Method: We retrospectively reviewed 944 patients with CHB who initiated antiviral therapy in five tertiary hospitals of Korea between May 2005 and July 2021. Results: Most patients were male (n = 527, 55.8%), and the median age was 50 years. During the follow-up period (median 47.7 months), 44 patients developed HCC. The aMAP score (66.3 vs. 60.1), aMAPLSMadvanced fibrosis (aMLaf; 97.4 vs. 72.7), and aMAP-LSMcirrhosis (aMLC;91.0 vs. 55.7) were significantly higher in patients who developed HCC than those who did not (all P < 0.05). Similarly, the PAGE-B score (16.0 vs. 12.0) and modified PAGE-B (mPAGE-B) score (12.5 vs. 10.0) were significantly higher in patients who developed HCC than those who did not (all P < 0.05). In multivariate analysis, an increased aMAP (hazard ratio [HR], 1.125; 95% confidence interval [CI], 1.003–1.225), aMLaf (HR, 1.049; 95% CI, 1.005–1.095), and aMLC (HR, 1.039; 95% CI, 1.008–1.071) were independently associated with the increased risk of HCC development (p < 0.05). The PAGE-B score (HR, 1.163; 95% CI, 1.028–1.315) and mPAGE-B score (HR, 1.205; 95% CI, 1.006–1.445) maintained their predictive significance after adjustment (p < 0.05). The areas under the curve (AUROCs) at 3 years of antiviral therapy were 0.843 for aMLaf, 0.839 for aMLC, 0.790 for aMAP, 0.764 for mPAGE-B, and 0.752 for PAGE-B, respectively. The AUROCs at 5 years of antiviral therapy were 0.802 for aMLaf, 0.799 for aMLC, 0.752 for aMAP, 0.718 for PAGE-B, and 0.716 for mPAGE-B, respectively. The AUROCs of aMLaf and aMLC at 3 and 5 years of antiviral therapy were significantly higher than those of the PAGE-B and mPAGE-B scores (p < 0.05). Conclusion: The aMAP score combined with LS helped to predict HCC development, and its performance was superior to that of PAGEB and mPAGE-B.