The Hong Kong Association for the Study of Liver Diseases International Symposium on Hepatology 2018 & 31 st Annual Scientific Meeting The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases HCC risk prediction – what's new? The Hong Kong Association for the Study of Liver Diseases Dr Grace Lai-Hung Wong The Hong Kong Association for the Study of Liver Diseases MBChB (Hons, CUHK), MD (CUHK), FRCP (Lond, Edin), FHKCP, FHKAM (Medicine) Professor, Institute of Digestive Disease The Chinese University of Hong Kong The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases Disclosures The Hong Kong Association for the Study of Liver Diseases • Advisory committee member: Gilead The Hong Kong Association for the Study of Liver Diseases • Speaker: AbbVie, Bristol-Myers Squibb, Echosens & Furui, Gilead, Janssen, Roche The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases HCC – top killer in areas endemic with hepatitis B virus (HBV) The Hong Kong Association for the Study of Liver Diseases • >250 million people chronically The Hong Kong Association for the Study of Liver Diseases infected with HBV worldwide – 80% in Asian-Pacific regions The Hong Kong Association for the Study of Liver Diseases • >350,000 new cases of HBV- related HCC annually The Hong Kong Association for the Study of Liver Diseases • >50% are too advanced for curative treatments The Hong Kong Association for the Study of Liver Diseases • >200,000 deaths every year http://www.cancerresearchuk.org/cancer-info/cancerstats/types/liver/incidence/ The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases Early diagnosis of HCC improves survival The Hong Kong Association for the Study of Liver Diseases HCC surveillance: ultrasound scan + alpha-fetoprotein every 6 months The Hong Kong Association for the Study of Liver Diseases Bruix & Sherman. Hepatology 2012 Sep;56(3):793-6. The Hong Kong Association for the Study of Liver Diseases Surveillance group: Smaller HCC (4.2 cm vs. 7.7 cm; p<0.001) Fewer HCC (2.6 vs. 3.8, p=0.03) The Hong Kong Association for the Study of Liver Diseases Longer survival (88 vs. 26 weeks; p<0.001) The Hong Kong Association for the Study of Liver Diseases However, 37.6% still died in 5 years The Hong Kong Association for the Study of Liver Diseases Wong GL, et al. Liver Int 2008;28:79-87
The Hong Kong Association for the Study of Liver Diseases WHO Targets for reducing new cases of and deaths from chronic viral hepatitis The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Majority of deaths are related to HCC The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases IDENTIFY PATIENTS AT RISK HCC RISK SCORES The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases Risk factors for HBV-related HCC The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Old Age High HBV DNA The Hong Kong Association for the Study of Liver Diseases Family History Positive HBeAg Gender (M > F) HBV/HCV/HIV coinfections Obesity, DM, The Hong Kong Association for the Study of Liver Diseases steatosis HBV Genotype Presence of hepatic (Genotype C > B inflammation / fibrosis in Asians), The Hong Kong Association for the Study of Liver Diseases Alcohol consumption PC/BCP mutations The Hong Kong Association for the Study of Liver Diseases Fattovich G. Semin Liver Dis 2003;23:47-58; Chen CJ, et al . JAMA 2006;295:65-73; Iloeje UH, et al . Gastroenterology 2006;130:678-86; Chen CJ J. Gastroenterol Hepatol 1997;12:S294-S308; Yang HI et al . NEJM 2002;347:168-174; Yang HI et al. JNCI 2008;100:1134-43
The Hong Kong Association for the Study of Liver Diseases Good HCC prediction model The Hong Kong Association for the Study of Liver Diseases • Simple, objective (clearly defined) variables The Hong Kong Association for the Study of Liver Diseases • Not fixed, but modifiable variables • Validated in various cohorts The Hong Kong Association for the Study of Liver Diseases • Acceptable to both academic and non-academic (private) hospital The Hong Kong Association for the Study of Liver Diseases • Easily applied in real practice The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases
The Hong Kong Association for the Study of Liver Diseases HCC risk scores for HBV-related HCC The Hong Kong Association for the Study of Liver Diseases CUHK cohort (CU-HCC) The Hong Kong Association for the Study of Liver Diseases Hospital clinic Training cohort: 1005 REVEAL-HBV cohort Validation cohort: 424 Community non-cirrhotic patients FU 10 years; 150 HCC The Hong Kong Association for the Study of Liver Diseases Training cohort: 2435 Validation cohort: 1218 FU 11 years; 164 HCC The Hong Kong Association for the Study of Liver Diseases HKU cohort (GAG-HCC) Hospital clinic Cohort: 820 The Hong Kong Association for the Study of Liver Diseases Leave-one-out cross-validation FU 6 years; 40 HCC Yuen et al. J Hepatol 2009;50:80 Wong VW et al. J Clin Oncol 2010;28:1660 The Hong Kong Association for the Study of Liver Diseases Yang et al. J Clin Oncol 2010;28:2437
The Hong Kong Association for the Study of Liver Diseases Factors in the HCC risk scores The Hong Kong Association for the Study of Liver Diseases CUHK cohort (CU-HCC) The Hong Kong Association for the Study of Liver Diseases Age, albumin, bilirubin, HBV DNA, cirrhosis REVEAL-HBV cohort Male gender, age, The Hong Kong Association for the Study of Liver Diseases family history, alcohol, ALT, HBeAg, HBV DNA Only applicable to non-cirrhotic patients The Hong Kong Association for the Study of Liver Diseases HKU cohort (GAG-HCC) Male gender, age, HBV DNA, cirrhosis The Hong Kong Association for the Study of Liver Diseases (core promoter mutations) Yuen et al. J Hepatol 2009;50:80 The Hong Kong Association for the Study of Liver Diseases Wong et al. J Clin Oncol 2010;28:1660 Yang et al. J Clin Oncol 2010;28:2437
The Hong Kong Association for the Study of Liver Diseases CU-HCC prediction scores The Hong Kong Association for the Study of Liver Diseases Category Factor Score The Hong Kong Association for the Study of Liver Diseases Age >50 +3 ≤50 0 Albumin (g/l) ≤35 +20 The Hong Kong Association for the Study of Liver Diseases >35 0 Bilirubin ( μ mol/l) >18 +1.5 ≤18 0 The Hong Kong Association for the Study of Liver Diseases HBV DNA (log copies/ml) ≤4 0 4 – 6 +1 >6 +4 The Hong Kong Association for the Study of Liver Diseases Cirrhosis Yes +15 No 0 The Hong Kong Association for the Study of Liver Diseases Wong VW et al. J Clin Oncol 2010;28:1660
The Hong Kong Association for the Study of Liver Diseases CU-HCC score accurately stratifies patients into 3 levels of cancer risk The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases HCC-free survival The Hong Kong Association for the Study of Liver Diseases Risk category 5 years 10 years <5 98.3% 97.1% 5 – 19 90.5% 71.0% The Hong Kong Association for the Study of Liver Diseases ≥20 78.9% 67.7% The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Wong et al. J Clin Oncol 2010;28:1660
The Hong Kong Association for the Study of Liver Diseases Antiviral therapy altered the natural history - Entecavir therapy reduces HCC in cirrhotic patients 1,466 entecavir-treated patients vs. 424 untreated patients (historical control) The Hong Kong Association for the Study of Liver Diseases Hazard ratio 0.55 (95% CI 0.31 – 0.99) The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases The Hong Kong Association for the Study of Liver Diseases Entecavir cohort Control cohort P = 0.036 The Hong Kong Association for the Study of Liver Diseases Patients at risk Entecavir cohort 482 466 365 194 81 20 The Hong Kong Association for the Study of Liver Diseases Control cohort 69 65 60 52 45 41 Wong GL, et al. Hepatology 2013;58:1537 – 1547.
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