Validity study of clinical scoring systems to predict Hepatocellular Carcinoma among chronic Hepatitis B carriers at St. Lukes Medical Center-Global City
Background: Chronic hepatitis B is the leading cause of cirrhosis and hepatocellular carcinoma in Asia. However, only a proportion of patients with chronic infection of hepatitis B virus will develop hepatocellular carcinoma. Stratifying patients with hepatitis B who are more likely to develop hepatocellular carcinoma will help to direct efforts of early interventions and more rigorous surveillance. Previous studies have identified a number of risk factors for hepatocellular carcinoma in patients with chronic hepatitis B virus. Risk scores for hepatocellular carcinoma have been proposed by different groups for hepatitis B virus carriers based on these risk factors. This study aims to validate three hepatocellular carcinoma risk scores: CU-HCC, GAG-HCC, and REACH-B scores, among patients diagnosed chronic hepatitis B from 2010-2013 at St. Luke's Medical Center - Global City.
Methods: This is a retrospective cohort study of all patients diagnosed with chronic hepatitis B in St. Luke's Medical Center - Global City from 2010 to 2013. The subjects were evaluated using the different hepatocellular carcinoma prediction risk scoring system, namely REACH-B, GAG-HCC, and CU-HCC. The subjects were stratified to low risk and high risk of developing hepatocellular carcinoma according to their different risk factors which includes age, sex, Hepatitis B virus level, liver function, reactivity of HBe antigen and the presence or absence of cirrhosis.
Results: The sensitivity, specificity, PPV and NPV of predicting hepatocellular carcinoma were 67%, 57%, 9% and 96% using REACH-B, 86%, 87%, 30% and 99% using GAG-HCC, and 86%, 65%, 17% and 98% using CU-HCC respectively.
Conclusion: The results showed high sensitivity and specificity of CU-HCC in predicting hepatocellular carcinoma among hepatitis B patients. However, the limitations of the study include a restrospective design, low study population and short duration of follow-up.