Validated Nationwide Scoring System for Hepatocellular Carcinoma Risk in Metabolic Dysfunction-Associated Steatotic...

Area of Science:

• Hepatology
• Oncology
• Public Health

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is common, but MASLD-related hepatocellular carcinoma (HCC) is rare, complicating risk stratification.
• Identifying high-risk MASLD patients for HCC surveillance is a significant public health challenge.

Purpose of the Study:

• To develop a practical scoring system for hepatocellular carcinoma (HCC) surveillance in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Main Methods:

• A cohort of 232,125 MASLD patients from Taiwan was used for development, with external validation in 28,045 MASLD patients from Hong Kong.
• A multivariable Fine-Gray subdistribution hazards model identified key risk factors: cirrhosis, age, male sex, and diabetes mellitus (CAMD).
• The CAMD score was developed and validated for HCC prediction accuracy using concordance indices and calibration analysis.

Main Results:

• The 10-year cumulative incidence of HCC in the development cohort was 0.41%.
• The CAMD score demonstrated good predictive performance with concordance indices ranging from 0.73 to 0.80 across different time points in both cohorts.
• A CAMD score greater than 13 identified high-risk patients with an average annual HCC incidence exceeding 0.2%.

Conclusions:

• The CAMD score is a simple, calculable tool for facilitating large-scale HCC surveillance in MASLD patients.
• This scoring system can aid clinicians in identifying individuals who would benefit most from intensive HCC monitoring.