Highlights
- •Age, cirrhosis, family history of HCC, and alcohol consumption independently predicted HCC development after HBsAg seroclearance.
- •A simple risk score using these 4 variables showed good discriminative performance and calibration for HCC prediction.
- •The first prediction model derived from HBsAg-cleared patients may be a useful reference for decision-making in surveillance.
Background & Aims
After hepatitis B surface antigen (HBsAg) seroclearance, the risk of hepatocellular
carcinoma (HCC) remains, and the optimal surveillance strategy has yet to be determined.
Herein, we aimed to evaluate incidence and risk factors for HCC and establish a novel
prediction model for HCC development after HBsAg seroclearance.
Methods
A total of 1,443 patients with chronic hepatitis B who achieved HBsAg seroclearance
between 1991 and 2020 were retrospectively screened for study eligibility. The data
from 831 of these patients were included in the final analysis. A prediction model
was developed based on multivariable Cox models. Harrell’s C-index and a time-dependent
AUROC were used for discrimination. Bootstrap analysis was performed for internal
validation.
Results
Overall, 40 patients (4.8%) developed HCC after HBsAg seroclearance during a follow-up
of 4,644 person-years (0.86%/year). Age at HBsAg seroclearance, presence of cirrhosis,
family history of HCC, and more-than-moderate alcohol consumption were independently
predictive of HCC, and these 4 independent variables were used to develop the prediction
model. The C-index of the model was 0.804. The time-dependent AUROCs of the score
for HCC prediction at 5, 10, and 15 years were 0.799, 0.835, and 0.817, respectively.
The score also showed good discrimination in the internal validation and sensitivity
analysis.
Conclusions
The novel prediction model based on age, cirrhosis, family history of HCC, and alcohol
consumption enables reliable risk estimation of HCC after HBsAg seroclearance and
may serve as a useful reference for decision-making in HCC surveillance for HBsAg-cleared
patients.
Lay summary
After spontaneous hepatitis B surface antigen (HBsAg) seroclearance, the risk of hepatocellular
carcinoma (HCC) remains. Age at HBsAg seroclearance, presence of cirrhosis, family
history of HCC, and more-than-moderate alcohol consumption were independently associated
with HCC development after HBsAg seroclearance. The novel prediction model using these
4 variables enables reliable risk estimation of HCC and serves as a useful reference
for decision-making in HCC surveillance and management for HBsAg-cleared patients.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 07, 2022
Accepted:
March 18,
2022
Received in revised form:
March 13,
2022
Received:
July 30,
2021
Footnotes
Author names in bold designate shared co-first authorship
Identification
Copyright
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
