New model predicts HCC risk in noncirrhotic CHB patients

A novel prognostic model based on the viral loads of hepatitis B virus (HBV) demonstrates its utility in predicting and stratifying the risk of hepatocellular carcinoma (HCC) in noncirrhotic patients with chronic hepatitis B (CHB) who are not yet receiving antiviral therapy.

This study involved a community-based cohort in Taiwan (REVEAL-HBV, REACH-B model cohort) and eight hospital-based cohort from Korea and Hong Kong (GAG-HCC and CU-HCC cohorts). Researchers derived the new model from 6,949 CHB patients from the Korean cohort and validated it in 7,429 patients from the Taiwanese cohort and seven cohorts from Korea and Hong Kong.

The derivation cohort identified 435 incident HCC cases over a median follow-up of 10.0 years, while the validation cohort found 467 cases over a median 12.2-year follow-up.

One of the strongest predictors of HCC development in the new model was baseline HBV DNA level, showing a nonlinear parabolic association in both cohorts, with moderate viral loads (about 6 log10 IU/mL) having the highest HCC risk. Other predictors were age, sex, platelet count, ALT levels, and positive hepatitis B e antigen result.

The new model demonstrated good discrimination and calibration, with c-statistics of 0.844 in the derivation cohort and 0.813 in the validation cohort with several imputation. It also generated a greater positive net benefit relative to other strategies in the 0-percent to 18-percent threshold.

The study, however, was limited by the lack of validation in cohorts of other races and receiving antiviral treatment.