Table_1_External Validation of aMAP Hepatocellular Carcinoma Risk Score in Patients With Chronic Hepatitis B-Related Cirrhosis Receiving ETV or TDF Therapy.DOCX

Background and Aim: A prediction model of hepatocellular carcinoma (HCC) risk in patients with chronic liver diseases, based on age, male sex, albumin-bilirubin, and platelets (aMAP), has been previously reported. We validated the aMAP score and compared its performance to those of other risk scores in an independent at-risk cohort.Methods: Treatment-naïve patients with chronic hepatitis B-related compensated cirrhosis who received entecavir or tenofovir monotherapy for at least 12 months were enrolled in this study. The performances of the aMAP and other HCC risk scores were assessed using Harrell's c-index, and predefined cut-off values were evaluated using survival analysis.Results: Of the 1,042 patients, 131 (12.6%) developed HCC during a median follow-up of 41 months. The aMAP score provided the highest Harrell's c-index (0.724), followed by CAMD (0.719), mPAGE-B (0.719), and PAGE-B (0.695). The 5-year cumulative HCC probabilities were 2.9% for patients with a low aMAP score (60). Using both aMAP and mPAGE-B, 11.6% of patients were identified as low risk with a negative predictive value of 98.2% for not developing HCC within 5 years. Patients with aMAP >60 and diabetes exhibited an extremely high risk of HCC, with a cumulative incidence of 49.3% at 5 years. The predictive performance of aMAP with a reassessment at 1 year after the initiation of antiviral therapy outperformed the predictive performance of aMAP at enrollment.Conclusions: The aMAP score accurately predicted the risk of HCC in at-risk patients with compensated cirrhosis undergoing antiviral therapy. A combination of the aMAP score and diabetes status could further stratify the risk of HCC.

背景与目标：基于年龄、男性性别、白蛋白-胆红素比（aMAP）和血小板计数（aMAP）等指标，针对慢性肝病患者的肝细胞癌（HCC）风险预测模型已先前报道。本研究旨在验证aMAP评分，并与其他风险评分在独立风险队列中的性能进行比较。方法：本研究纳入了接受恩替卡韦或替诺福韦单药治疗至少12个月的慢性乙型肝炎相关代偿期肝硬化未治疗患者。使用Harrell的c指数评估了aMAP及其他HCC风险评分的性能，并使用生存分析评估了预定义的截止值。结果：在1042名患者中，有131名（12.6%）在平均随访41个月时发展为HCC。aMAP评分提供了最高的Harrell的c指数（0.724），其次是CAMD（0.719）、mPAGE-B（0.719）和PAGE-B（0.695）。对于aMAP评分较低的患者（60分），5年累计HCC概率为2.9%。结合aMAP和mPAGE-B评分，11.6%的患者被识别为低风险，5年内不发展为HCC的阴性预测值为98.2%。aMAP评分大于60且患有糖尿病的患者表现出极高的HCC风险，5年累计发病率为49.3%。在抗病毒治疗开始后1年进行的aMAP再评估的预测性能优于入组时的aMAP预测性能。结论：aMAP评分能够准确预测接受抗病毒治疗的代偿期肝硬化患者的HCC风险。结合aMAP评分和糖尿病状态可以进一步分层HCC风险。