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Abstract Details
Comparing Predicted Probability of Hepatocellular Carcinoma in Patients With Cirrhosis With the General Population: An Opportunity to Improve Risk Communication?
Am J Gastroenterol. 2022 Sep 1;117(9):1454-1461. doi: 10.14309/ajg.0000000000001879.Epub 2022 Jun 24.
1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
2Public Health Scotland, Glasgow, UK.
3Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
4Royal Infirmary of Edinburgh, Edinburgh, UK.
5Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
6Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK.
7Glasgow Royal Infirmary, Glasgow, UK.
8Aberdeen Royal Infirmary, Aberdeen, UK.
9Queen Elizabeth University Hospital, Glasgow, UK.
Abstract
Introduction: Risk scores estimating a patient's probability of a hepatocellular carcinoma (HCC) diagnosis are abundant but are difficult to interpret in isolation. We compared the predicted HCC probability for individuals with cirrhosis and cured hepatitis C with the general population (GP).
Methods: All patients with cirrhosis achieving sustained viral response (SVR) in Scotland by April 2018 were included (N = 1,803). The predicted 3-year probability of HCC at time of SVR achievement was determined using the aMAP prognostic model. GP data on the total number of incident HCCs in Scotland, stratified by demographics, were obtained from Public Health Scotland. Predicted HCC risk of cirrhosis SVR patients was compared with GP incidence using 2 metrics: (i) incidence ratio: i.e., 3-year predicted probability for a given patient divided by the 3-year probability in GP for the equivalent demographic group and (ii) absolute risk difference: the 3-year predicted probability minus the 3-year probability in the GP.
Results: The mean predicted 3-year HCC probability among cirrhosis SVR patients was 3.64% (range: 0.012%-36.12%). Conversely, the 3-year HCC probability in the GP was much lower, ranging from <0.0001% to 0.25% depending on demographics. The mean incidence ratio was 410, ranging from 5 to >10,000. The mean absolute risk difference was 3.61%, ranging from 0.012% to 35.9%. An online HCC-GP comparison calculator for use by patients/clinicians is available at https://thrive-svr.shinyapps.io/RShiny/ .
Discussion: Comparing a patient's predicted HCC probability with the GP is feasible and may help clinicians communicate risk information and encourage screening uptake.