Validation of risk prediction models for the development of HBV-related HCC: a retrospective multi-center 10-year follow-up cohort study

Abstract

Recently, modified REACH-B (mREACH-B) risk prediction model for hepatocellular carcinoma (HCC) development was proposed. We validated the accuracy of the mREACH-B model and compared its accuracy with those of other prediction models. Between 2006 and 2012, 1,241 patients with chronic hepatitis B (CHB) were recruited. All patients underwent transient elastography at enrollment. The median age of the study population (840 males, 401 females) was 49 years. The median PAGE-B, LSM-HCC, and mREACH-B values were 10, 10, and 8, respectively. Among patients without cirrhosis (n = 940, 75.7%), the median REACH-B value was 9. During the follow-up period (median 77.4 months), 66 (5.3%) and 83 (6.7%) patients developed HCC and liver-related events (LRE), respectively. Higher liver stiffness (LS) independently predicted HCC (hazard ratio [HR] = 1.047) and LRE development (HR = 1.047) (all P < 0.05). The mREACH-B significantly predicted HCC (AUC = 0.824 at 3-year and 0.750 at 5-year) and LRE development (AUC = 0.782 at 3-year and 0.739 at 5-year) (all P < 0.001) and it performed similarly or significantly better than the PAGE-B and LSM-HCC (AUC = 0.715-0.809 at 3-year and 0.719-0.742 at 5-year for HCC; AUC = 0.704-0.777 at 3-year and 0.721-0.735 at 5-year for LRE). Among patients without cirrhosis, mREACH-B predicted HCC (AUC = 0.803 vs. 0.654-0.816 at 3-year and 0.684 vs. 0.639-0.738 at 5-year) and LRE development (AUC = 0.734 vs. 0.619-0.789 at 3-year and 0.674 vs. 0.626-0.729 at 5-year) similarly to PAGE-B, REACH-B, and LSM-HCC. mREACH-B appropriately predicted HCC and LRE development in patients with CHB and showed similar or superior accuracy to those of PAGE-B, REACH-B, and LSM-HCC.