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Validation of Texas Hepatocellular Carcinoma Consortium Risk Index in the Hepatocellular Carcinoma Early Detection
Fasiha Kanwal1, Camden Lopez2, Jing Ning3
1Section of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas; Houston VA Health Services Research and Development Service Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas.
Insights
The Texas HCC Consortium Risk Index (THCC-RI) accurately predicts hepatocellular carcinoma (HCC) risk in cirrhosis patients. This validated model shows stable performance over five years, aiding clinical decision-making for HCC surveillance.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Hepatocellular carcinoma (HCC) poses a significant risk for patients with cirrhosis.
- The Texas HCC Consortium Risk Index (THCC-RI) was previously developed for HCC risk stratification in this population.
- External validation of the THCC-RI in a new cohort is crucial for assessing its generalizability.
Purpose of the Study:
- To externally validate the Texas HCC Consortium Risk Index (THCC-RI) for hepatocellular carcinoma (HCC) risk prediction.
- To assess the performance and calibration of THCC-RI in a prospective, independent cohort of patients with cirrhosis.
- To evaluate the long-term predictive accuracy of THCC-RI over a 5-year follow-up period.
Main Methods:
- A prospective cohort study utilizing data from the Hepatocellular Carcinoma Early Detection Strategy (HEDS) Study.
- Inclusion of 1,560 patients with cirrhosis undergoing regular HCC surveillance across seven U.S. centers.
- Follow-up until HCC diagnosis, liver transplantation, death, or December 2023, with analysis of risk prediction metrics.
Main Results:
- The THCC-RI demonstrated a C-index of 0.77, indicating good discriminative ability for HCC risk.
- Area Under the Receiver Operating Characteristic (AUROC) curves showed stable performance over time (0.77 at 1 year, 0.73 at 3 years, 0.71 at 5 years).
- High-risk individuals (top deciles) identified by THCC-RI had a 3.5-fold increased risk of HCC compared to medium-risk groups.
Conclusions:
- The THCC-RI exhibits robust performance in predicting HCC risk among patients with cirrhosis in an independent, multi-center cohort.
- The model maintained stable discrimination and calibration over a 5-year follow-up period.
- Further research is warranted to facilitate the clinical implementation of THCC-RI into standard care pathways for HCC surveillance.
Background & Aims:
We previously developed a hepatocellular carcinoma (HCC) risk stratification model, the Texas HCC Consortium Risk Index (THCC-RI), for patients with cirrhosis. In this cohort study, we aimed to externally validate THCC-RI in a prospective cohort of patients with cirrhosis.
Methods:
We used data from the Hepatocellular Carcinoma Early Detection Strategy (HEDS) Study, a prospective cohort of patients with cirrhosis enrolled in regular HCC surveillance at 7 centers in the United States. Patients were followed from enrollment until HCC diagnosis, liver transplantation, death, or December 2023.
Results:
The analysis was conducted in 1560 patients who contributed a total of 5051 person-years of follow-up (mean age, 59 years; 47% women; 40% with hepatitis C; 16% alcohol-associated disease; and 22% metabolic dysfunction-associated steatotic liver disease). Over a median follow-up of 2.5 years, 114 patients developed HCC. The THCC-RI had a C-index of 0.77 (95% confidence interval [CI], 0.64-0.85), with area under the receiver operating characteristic curve estimates of 0.77 (95% CI, 0.65-0.85) at 1 year, 0.73 (95% CI, 0.66-0.79) at 3 years, and 0.71 (95% CI, 0.65-0.77) at 5 years. THCC-RI was well-calibrated, with good agreement between observed and predicted risk. Compared with the medium-risk group (deciles 3-8), the high-risk group (deciles 9, 10) had 3.5-fold (hazard ratio, 3.5; 95% CI, 2.4-5.1) higher risk of HCC. THCC-RI had similar discrimination as the Age, Male, Albumin-bilirubin, and Platelets (aMAP) score during the first 2 years of follow-up, but the areas under the receiver operating characteristic curve for aMAP dropped more than those for THCC-RI as the time horizon expanded beyond 3 years.
Conclusions:
In an independent multi-center cohort, THCC-RI had good performance for predicting the future risk of HCC in patients with cirrhosis, with stable discrimination and calibration over a 5-year follow-up. Implementation of THCC-RI into clinical care pathways requires further research.
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