Research Papers:

Development of a nomogram for screening of hepatitis B virus-associated hepatocellular carcinoma

Jung Wha Chung, Eun Sun Jang, Jaihwan Kim, Sook-Hyang Jeong, Nayoung Kim, Dong Ho Lee, Kyung Ho Lee and Jin-Wook Kim _

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Oncotarget. 2017; 8:106499-106510. https://doi.org/10.18632/oncotarget.22498

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Jung Wha Chung1,*, Eun Sun Jang1,*, Jaihwan Kim1, Sook-Hyang Jeong1,2, Nayoung Kim1,2, Dong Ho Lee1,2, Kyung Ho Lee3 and Jin-Wook Kim1,2

1Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

3Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

*These authors contributed equally to this work

Correspondence to:

Jin-Wook Kim, email: [email protected]

Keywords: chronic hepatitis B; hepatocellular carcinoma; nomograms; early diagnosis of cancer; ultrasonography

Received: August 06, 2017     Accepted: October 28, 2017     Published: November 18, 2017


Current strategy of hepatocellular carcinoma (HCC) surveillance evaluates individual risks of HCC for defining candidates for surveillance, but estimated risks are not utilized for clinical decision-making during actual screening. We sought to determine whether consideration of individual risks improve the performance of ultrasound (US)-based HCC screening in a real-world chronic hepatitis B (CHB) cohort. This single center retrospective cohort study analyzed 27,722 screening US tests from 4,175 consecutive CHB patients. Logistic regression analysis was performed to identify independent parameters predicting presence of HCC. A nomogram was built based on the independent predictors of HCC and compared with US-only screening by receiver operating characteristics analysis. The cost-effectiveness of the nomogram was assessed by decision curve analysis. HCC developed in 222 patients with the incidence of 0.769 per 1000 person-year during the median follow-up of 63 months. Age, sex, presence of cirrhosis, serum alpha-fetoprotein (AFP) levels and positive US test results were independent predictors of HCC presence. A nomogram based on these predictors showed higher C-statistics compared to US-only screening (0.960 vs. 0.731 and 0.935 vs. 0.691 for derivation and validation cohort, respectively; p < 0.001). Decision curve analysis showed higher net benefit of the HCC nomogram-guided screening model compared to US-only screening in the risk threshold range between 0 and 0.3. A nomogram composed of age, sex, presence of cirrhosis, serum AFP levels and US findings better predicted the presence of HCC compared to US-only screening in CHB on surveillance.

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