Prediction Model for Risk of Hepatocellular Carcinoma After Hepatitis C Viral Eradication.

Purpose: The predictors of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC) and a sustained virologic response after direct-acting antiviral therapy are not well known.

Patients and methods: Between September 2012 and March 2022, this retrospective study enrolled 4426 consecutive patients from 4 hospitals in Taiwan. The patients were divided into derivation (n = 3178) and validation (n = 1248) groups.

Results: In the derivation group, age, diabetes mellitus, platelet, albumin, and alpha-fetoprotein at 12 weeks after antiviral therapy were independent predictors of hepatocellular carcinoma. We incorporated these predictors into a novel risk prediction model called the AAAPD-C score (age, albumin, alpha-fetoprotein level, platelet count, and diabetes mellitus status), with total risk scores ranging from 0 to 12. The AAAPD-C score had an area under the receiver operating characteristic curve of 0.867 for the validation group at the end of follow-up. The risk score accurately classified patients in both groups into those with low, medium, and high risks. Patients without advanced liver fibrosis with medium-high AAAPD-C risk scores (4-12) had an annual incidence of HCC >4 per 1000 person-years.

Conclusion: The AAAPD-C score can predict the risk of HCC in patients with chronic hepatitis C and a sustained virologic response after direct-acting antiviral therapy. The tool is accurate and inexpensive, and clinicians can use it to identify patients with chronic hepatitis C at risk of HCC following viral eradication.