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Prediction of hepatocellular carcinoma in a portuguese population after hepatitis C cure : comparative accuracy of noninvasive tests (transient elastography, FIB-4, and aMAP)

2025-06Contributo em revista Acesso aberto
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datacite.subject.fosCiências Médicas::Ciências da Saúde
datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorMascarenhas, André
dc.contributor.authorSerrazina, Juliana
dc.contributor.authorBronze, Sérgio
dc.contributor.authorCortez-Pinto, Helena
dc.contributor.authorPresa, José
dc.contributor.authorBarreira, Ana
dc.contributor.authorCarrola, Paulo
dc.contributor.authorVara-Luiz, Francisco
dc.contributor.authorRosu-Pires, Alexandra
dc.contributor.authorMartins, Pedro Lages
dc.contributor.authorPrata, Rita
dc.contributor.authorRevés, Joana
dc.contributor.authorBravo, Catarina
dc.contributor.authorNascimento, Catarina
dc.contributor.authorGouveia, Catarina
dc.contributor.authorFranco, Ana Rita
dc.contributor.authorLima, Pedro
dc.contributor.authorO’Neill, Catarina
dc.contributor.authorMendes, Raquel R.
dc.contributor.authorSimão, Inês Rodrigues
dc.contributor.authorSantos, Inês Costa
dc.contributor.authorGonçalves, André Ruge
dc.contributor.authorBarreiro, Pedro
dc.contributor.authorMendo, Rui
dc.contributor.authorBarosa, Rita
dc.contributor.authorFigueiredo, Pedro
dc.contributor.authorChagas, Cristina
dc.contributor.authoron behalf of “Hepatologia em Rede”
dc.date.accessioned2026-05-20T15:05:02Z
dc.date.available2026-05-20T15:05:02Z
dc.date.issued2025-06
dc.description.abstractIntroduction: Chronic infection with hepatitis C virus (HCV) causes 25% of hepatocellular carcinoma (HCC) cases worldwide, a major cause of morbimortality even after sustained virologic response (SVR). Universal screening to all patients with advanced liver fibrosis is currently recommended. A risk-based strategy could improve the detection rate of early HCC and diminish the surveillance burden. Although several risk prediction models exist, exclusion of a subgroup of patients from surveillance has not yet been recommended. The objective of this study was the comparison of the predictive accuracy of transient elastography, FIB-4, and aMAP for HCC in HCV patients after SVR in Portugal. Methods: This was a multicentric retrospective study including patients with HCV after SVR. Comparative, univariate, multivariate, area under the ROC (receiver-operating characteristic) curve (AUC), and Youden’s J-statistic analysis were performed. Results: HCC incidence was 4.2% (1.3/100 patient-years) after a median follow-up of 31 months with inclusion of 337 patients. All patients had a liver stiffness measurement (LSM) before SVR (considered the baseline), but only 148 (43.9%) had a transient elastography after SVR. FIB-4 and aMAP post-SVR were calculated in all patients. Multiple parameters positively correlated with HCC, but only age and baseline transient elastography remained as independent predictors in the multivariate analysis. The optimal cutoffs for prediction of HCC were baseline transient elastography 13.7 kPa, post-SVR transient elastography 16.5 and 15.8 kPa (first and last measurements, respectively), FIB-4 1.6, and aMAP 58. Baseline transient elastography revealed a fair accuracy in predicting HCC (AUC 0.776, p < 0.001), with the cutoff of 13.7 kPa presenting a sensitivity of 85% and a specificity of 69%. Regarding patients who were F3–4 at baseline (n = 162), almost one-third had a baseline LSM ≤13.7 kPa (n = 51, 31.5%), an FIB-4 ≤1.6 (n = 50, 30.9%), and an aMAP score ≤58 (n = 48, 29.6%), and these cutoffs presented an NPV of 98%, 94%, and 96%, respectively, when considering HCC development. Conclusion: Transient elastography (FibroScan) before SVR was a fair predictor of HCC, being more accurate than FIB-4 and aMAP. Transient elastography values ≤13.7 kPa at baseline, FIB-4 ≤1.6 and aMAP ≤58 were the cutoffs considered of low risk for HCC in a Portuguese cohort of HCV patients after SVR with advanced fibrosis. aMAP score is a risk-based surveillance tool that could improve the current HCC screening strategy, but further validation is needed.eng
dc.identifier.citationAndré Mascarenhas, Juliana Serrazina, Sérgio Bronze, Helena Cortez-Pinto, José Presa, Ana Barreira, Paulo Carrola, Francisco Vara-Luiz, Alexandra Rosu-Pires, Pedro Lages Martins, Rita Prata, Joana Revés, Catarina Bravo, Catarina Nascimento, Catarina Gouveia, Ana Rita Franco, Pedro Lima, Catarina O’Neill, Raquel R. Mendes, Inês Rodrigues Simão, Inês Costa Santos, André Ruge Gonçalves, Pedro Barreiro, Rui Mendo, Rita Barosa, Pedro Figueiredo, Cristina Chagas, On behalf of “Hepatologia em Rede”; Prediction of Hepatocellular Carcinoma in a Portuguese Population after Hepatitis C Cure: Comparative Accuracy of Noninvasive Tests (Transient Elastography, FIB-4, and aMAP). GE Port J Gastroenterol 3 June 2025; 32 (3): 161–173. https://doi.org/10.1159/000540700
dc.identifier.doi10.1159/000540700
dc.identifier.issn2387-1954
dc.identifier.urihttp://hdl.handle.net/10400.26/63223
dc.language.isoeng
dc.peerreviewedyes
dc.publisherKarger
dc.relation.hasversionhttps://doi.org/10.1159/000540700
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectChronic hepatitis C
dc.subjectHepatocellular carcinoma
dc.subjectRisk assessment
dc.subjectScreening
dc.subjectSustained virologic response
dc.titlePrediction of hepatocellular carcinoma in a portuguese population after hepatitis C cure : comparative accuracy of noninvasive tests (transient elastography, FIB-4, and aMAP)eng
dc.typecontribution to journal
dspace.entity.typePublication
oaire.citation.endPage173
oaire.citation.issue3
oaire.citation.startPage161
oaire.citation.titleGE – Portuguese Journal of Gastroenterology
oaire.citation.volume32
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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