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. 2025 Apr;45(4):e70065.
doi: 10.1111/liv.70065.

Behaviour-Based Predictive Scores of Hepatocellular Carcinoma in People With Chronic Hepatitis B (ANRS CO22 HEPATHER)

Clémence Ramier  1 , Camelia Protopopescu  1 , Vincent Di Beo  1 , Lucia Parlati  2 , Fabienne Marcellin  1 , Fabrice Carrat  3   4 , Tarik Asselah  5 , Marc Bourlière  1   6 , Patrizia Carrieri  1 ; ANRS/AFEF CO22 HEPATHER Study Group
Collaborators, Affiliations

Behaviour-Based Predictive Scores of Hepatocellular Carcinoma in People With Chronic Hepatitis B (ANRS CO22 HEPATHER)

Clémence Ramier et al. Liver Int. 2025 Apr.

Abstract

Background and aims: Early assessment of hepatocellular carcinoma (HCC) risk could improve long-term outcomes in people with chronic hepatitis B virus (HBV) infection. Some existing HCC predictive scores are not easily implementable. We developed easy-to-use HCC predictive scores based on behavioural and routine bio-clinical data in people with chronic HBV infection.

Methods: Eight-year follow-up data was analysed from people with chronic HBV infection enrolled in the French ANRS CO22 HEPATHER cohort. Patients were randomly split into two samples (training/testing). A multivariable Cox model for time to HCC was estimated on the training sample. The HCC predictive score was computed by summing the points assigned to model predictors, normalising their coefficients over a 10-year age increment, and rounding to the nearest integer. The Youden index identified the score's optimal risk threshold. Comparisons with existing predictive scores were performed on the testing sample.

Results: In the study population (N = 4370; 63% of men; 65% of < 50 years old), 56 HCC cases occurred during 25,900 follow-up person-years. Two HCC predictive scores were defined: SADAPTT (daily soft drink consumption, age, hepatitis Delta infection, unhealthy alcohol use, platelet count, heavy tobacco smoking, and HBV treatment) and ADAPTT (the same predictors except for daily soft drink consumption), with ranges 0-13 and 0-14, respectively, and values ≥ 3 indicating a high HCC risk. Their performances were similar to existing scores.

Conclusions: We developed two effective behaviour-based HCC predictive scores, implementable in many settings, including primary care and decentralised areas. Further studies are needed to validate these scores in other datasets.

Keywords: alcohol; hepatitis B; hepatitis Delta; liver cancer; soft drink; tobacco.

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Conflict of interest statement

L.P. reports non‐financial support from Gilead Sciences, Abbvie, Novo Nordisk, and MSD, not related to this study. T.A. is a speaker and investigator for Antios Therapeutics, AbbVie, Eiger Bio‐Pharmaceuticals, Enyo Pharma, Gilead Sciences, GSK, Janssen, Vir Biotechnology, and Roche. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Selection of the study population (ANRS CO22 HEPATHER). HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus.
FIGURE 2
FIGURE 2
Kaplan–Meier curves for the SADAPTT and ADAPTT scores on the testing sample, stratified by each score's specific threshold (ANRS CO22 HEPATHER, N = 1314).
See this image and copyright information in PMC

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