Cheung KS, et al. - The researchers performed this study to describe the role of aminotransferase to platelet ratio index (APRI), alone and in combination with treatment response, in predicting hepatocellular carcinoma (HCC) development in primary biliary cholangitis (PBC). They confirmed the usefulness of APRI at 1 year after treatment (APRI-r1) in predicting HCC development in PBC patients. The combination of APRI-r1 with treatment response allowed further stratification of HCC risk.

Methods

• From 2000 and 2015, the researchers identified PBC patients by searching the electronic medical database of a tertiary center.
• They used Cox proportional hazards model to determine the hazard ratio (HR) of HCC with different risk factors.

Results

• The researchers recruited 144 PBC patients.
• They diagnosed patients at a median age of 57.8 years [interquartile range (IQR): 48.7-71.5 years), and 41 (28.5%) patients had cirrhosis at baseline.
• The median follow-up duration was 6.9 years (range: 1.0-26.3 years).
• With an incidence rate of 10.6 cases per 1000 patient-years, 12 patients developed HCC.
• In this study, the overall 5-, 10- and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4% (95%CI: 1.8%-14.5%) and 21.6% (6.8%-34.1%), respectively.
• Independent factors for HCC development were older age (HR = 1.07), cirrhosis (HR = 4.38) and APRI at 1 year after treatment (APRI-r1) > 0.54 (HR = 3.94).
• APRI-r1 further stratified HCC risk (log-rank P < 0.05), when combined with treatment response.
• In predicting HCC, the area under receiver operating curve of APRI-r1 was 0.77 (95%CI: 0.64-0.88).