TOPLINE

A multicenter cohort study found that the Toronto hepatocellular carcinoma (HCC) risk index (THRI), a score based on routine patient data and etiology of cirrhosis, identified patients with cirrhosis who had a near-negligible 5-year risk for HCC more effectively than the highly validated aMAP risk-stratification score. Among patients classified as low-risk by aMAP, about two-thirds were reclassified as higher risk by THRI and had a substantially higher 5-year HCC incidence than patients classified as low-risk by both scores.

METHODOLOGY

• A personalized HCC surveillance approach could help doctors safely reduce monitoring in low-risk patients while focusing attention on those at higher risk, but this depends on reliable risk scores that use routine clinical data.
• Researchers conducted a retrospective cohort study to directly compare the performance of the THRI and aMAP score in identifying patients with cirrhosis who are at low risk for HCC. THRI is based on age, sex, platelet count, and cirrhosis cause, and aMAP is based on age, sex, albumin-bilirubin level, and platelet count.
• Both scores stratified patients with cirrhosis into low-, intermediate-, and high-risk groups for HCC.
• The study included 1531 patients with cirrhosis (median age, 53 years; 63% men) from three Dutch centers and followed them for a median duration of 5.4 years.
• Most patients (60%) had nonviral liver disease, including steatotic liver disease, while the remaining 40% had viral hepatitis, including hepatitis C and hepatitis B infections. 

TAKEAWAY

• During follow up, 196 patients developed HCC. The overall 3-year and 5-year cumulative incidence of HCC was 3.4% and 7.2%, respectively.
• The THRI showed better discrimination of risk for HCC than the aMAP score at both 3 years (area under the curve [AUC], 0.74 vs 0.64) and 5 years (AUC, 0.73 vs 0.70) across the full cohort. 
• A THRI low risk cut-off below 120 identified low-risk patients more accurately than aMAP, with higher sensitivity (98.8% vs. 87.2%) and a much lower 5-year HCC risk in the low-risk group (0.5% vs. 2.9%); when the aMAP cut-off was lowered to 45 to improve sensitivity, the share of patients labeled low risk fell to 15%—similar to THRI <120 at 18%—but the 5-year HCC risk in that low-risk group was still higher than with THRI (1.9% vs. 0.5%).
• Among patients classified as low risk by the aMAP score, only 32% were also classified as low risk by THRI. The 5-year HCC incidence was 0% among patients classified as low-risk by both scores compared with 4.3% among those classified as intermediate or higher risk on THRI but low-risk on aMAP (P = .009).

IN PRACTICE

"THRI appears to be more effective in identifying patients with a negligible 5-year risk of HCC, and could be utilized to inform personalized HCC surveillance strategies, particularly in supporting deferral decisions in low-risk patients with cirrhosis," the authors wrote.

SOURCE

The study was led by Mohamed Moussa, Erasmus MC,  Rotterdam, Netherlands. It was published online in Digestive and Liver Disease.

LIMITATIONS

The retrospective study design and nonstandardized surveillance practices may have introduced selection bias. The study included patients from Netherlands, which may have limited the applicability of the findings to populations with different distributions of liver disease etiologies. The analysis evaluated only the THRI and aMAP score and did not assess other HCC risk-prediction models or biomarker-based approaches.

DISCLOSURES

The study was funded by The Foundation for Liver and Gastrointestinal Research, Rotterdam, Netherlands. Several authors reported receiving speakers’ fees, grants, and research support from, and serving as consultants for multiple companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.