aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis.

Abstract Background & Aims Hepatocellular carcinoma (HCC) is the leading cause of death in patients with chronic hepatitis. In this international collaboration, we sought to develop a global universal HCC risk score to predict the HCC development for chronic hepatitis patients. Methods A total of 17,374 patients, comprising 10,578 treated Asian chronic hepatitis B (CHB) patients, 2510 treated Caucasian CHB patients, 3566 treated hepatitis C virus (HCV)-infected patients (including 2489 patients with cirrhosis achieving a sustained virologic response) and 720 non-viral hepatitis (NVH) patients from 11 international prospective observational cohorts or randomized controlled trials, were divided into a training cohort (3688 Asian CHB patients) and 9 validation cohorts with different aetiologies and ethnicities (N =13,686). Results We developed an HCC risk score, called the aMAP score (ranging from 0 to 100), that involves only a ge, M ale, A lbumin-bilirubin and P latelets. This metric performed excellently in assessing HCC risk not only in patients with hepatitis of different aetiologies but also in those with different ethnicities (c-index: 0.82-0.87). Cut-off values of 50 and 60 were best for discriminating HCC risk. The 3- or 5-year cumulative incidences of HCC were 0-0.8%, 1.5-4.8%, and 8.1-19.9% in the low- (N=7413, 43.6%), medium- (N=6529, 38.4%), and high-risk (N =3044, 17.9%) groups, respectively. The cut-off value of 50 was associated with a sensitivity of 85.7-100% and a negative predictive value of 99.3-100%. The cut-off value of 60 resulted in a specificity of 56.6-95.8% and a positive predictive value of 6.6-15.7%. Conclusions This objective, simple, reliable risk score based on five common parameters accurately predicts HCC development, regardless of aetiology and ethnicity, which may help to establish a risk score-guided HCC surveillance strategy worldwide.