Novel Nomogram for Predicting Hepatocellular Carcinoma in Hepatitis C virus-associated Cirrhosis Patients after eliminating virus with Direct-acting Antivirals

Abstract

Abstract Background and aims:Hepatitis C virus (HCV) associated cirrhosis are in high risk of hepatocellular carcinoma (HCC), and this study aimed to explore the risk factors, and establish and validate a novel nomogram. Methods: A total of 309 inpatients with HCV- associated cirrhosis from Tianjin Second People's Hospital were selected as the training cohort, and 363 patients from Beijing You’an Hospital were selected as the validation cohort. Both cohorts received Direct-Acting Antiviral Agents (DAAs) treatment and achieved sustained virological response (SVR). Laboratory parameters were collected at baseline and duration of follow-up. Cox regression analysis was used to explore risk factors of HCC, and a nomogram for prediction was developed and validated. Results: HCC incidence was 5.45 100PY (95% CI, 3.91-7.40) in patients of the training cohort. Age, nonspecific liver nodules, the albumin-Bilirubin (ALBI) score and end of treatment (EOT)-AFP are independent risk factors for HCC by Cox regression analysis. A nomogram was used to predict the 1-year, 3-year and 5-year incidence of HCC, with the areas under receiver operating characteristic curves (AUROCs) of 0.866, 0.813 and 0.764, respectively. The AUROCs in validation cohort at 1, 3, and 5 years were 0.884, 0.783 and 0.692 in this nomogram, respectively. Conclusion: This novel nomogram had a good predictive ability for HCC in patients with HCV-associated cirrhosis after eliminating virus with direct-acting antiviral agents, especially in 3 years.