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Published on: September 30, 2021
Predictive performance and clinical utility of HCC risk scores in chronic hepatitis C: a comparative study
Gamal Shiha1,2, Nabiel N H Mikhail3,4, Reham Soliman3,5
1Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, Mansoura, Egypt. g_shiha@hotmail.com.
Insights
Certain risk scores effectively predict hepatocellular carcinoma (HCC) in chronic hepatitis C (CHC) patients after treatment. ADRES, GES, and Watanabe scores, incorporating AFP dynamics, show clinical utility for risk stratification and potentially avoiding unnecessary screening.
Area of Science:
- Hepatology
- Oncology
- Clinical Medicine
Background:
- Hepatocellular carcinoma (HCC) risk stratification is crucial for chronic hepatitis C (CHC) patients.
- Numerous HCC risk prediction scores exist, necessitating comparative analysis for clinical utility.
- Identifying patients needing intensified surveillance versus those not requiring screening is a key challenge.
Purpose of the Study:
- To compare the discriminative ability and clinical utility of various HCC risk prediction scores.
- To evaluate the performance of newer HCC risk scores in a large cohort of CHC patients who achieved sustained virologic response (SVR) after direct-acting antiviral (DAA) therapy.
- To identify scores that can reliably stratify HCC risk and inform surveillance strategies.
Main Methods:
- Evaluation of 12 HCC risk scores in 3075 CHC patients achieving SVR post-DAAs.
- Statistical analysis included Log rank tests and Harrell's c statistic.
- Assessment of HCC risk stratification and negative predictive values (NPVs) over 5-year follow-up.
Main Results:
- HCC developed in 212 patients within 5 years.
- ADRES, GES (pre- and post-treatment), GES algorithm, and Watanabe (post-treatment) scores demonstrated good statistical performance (Log rank < 0.001, Harrell's C 0.66-0.83, NPVs 94.38-97.65%).
- These scores showed very low 5-year cumulative incidence rates (0.54-1.6%) in low-risk groups, suggesting safe avoidance of screening.
Conclusions:
- ADRES, GES (pre- and post-treatment), GES algorithm, and Watanabe (post-treatment) scores offer acceptable HCC risk predictability and clinical utility in CHC patients.
- The inclusion of alpha-fetoprotein (AFP) dynamics in these scores may contribute to their superior performance.
- These validated scores can aid in personalized HCC surveillance strategies for CHC patients post-SVR.
Background And Aim:
Many HCC risk prediction scores were developed to guide HCC risk stratification and identify CHC patients who either need intensified surveillance or may not require screening. There is a need to compare different scores and their predictive performance in clinical practice. We aim to compare the newest HCC risk scores evaluating their discriminative ability, and clinical utility in a large cohort of CHC patients.
Patients And Methods:
The performance of the scores was evaluated in 3075 CHC patients who achieved SVR following DAAs using Log rank, Harrell's c statistic, also tested for HCC-risk stratification and negative predictive values.
Results:
HCC developed in 212 patients within 5 years follow-up. Twelve HCC risk scores were identified and displayed significant Log rank (p ≤ 0.05) except Alonso-Lopez TE-HCC, and Chun scores (p = 0.374, p = 0.053, respectively). Analysis of the remaining ten scores revealed that ADRES, GES pre-post treatment, GES algorithm and Watanabe (post-treatment) scores including dynamics of AFP, were clinically applicable and demonstrated good statistical performance; Log rank analysis < 0.001, Harrell's C statistic (0.66-0.83) and high negative predictive values (94.38-97.65%). In these three scores, the 5 years cumulative IR in low risk groups be very low (0.54-1.6), so screening could be avoided safely in these patients.
Conclusion:
ADRES, GES (pre- and post-treatment), GES algorithm and Watanabe (post-treatment) scores seem to offer acceptable HCC-risk predictability and clinical utility in CHC patients. The dynamics of AFP as a component of these scores may explain their high performance when compared to other scores.
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