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      The hepatocellular carcinoma risk in patients with HBV-related cirrhosis: a competing risk nomogram based on a 4-year retrospective cohort study

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          Abstract

          Objective

          The study aimed to build and validate a competitive risk nomogram to predict the cumulative incidence of hepatocellular carcinoma (HCC) for patients with hepatitis B virus (HBV)-related cirrhosis.

          Methods

          A total of 1401 HBV-related cirrhosis patients were retrospectively enrolled from January 1, 2011 to December 31, 2014. Application of 20 times imputation dealt with missing data using multiple imputation by chained equations (MICE). The patients were randomly divided into a training set ( n = 1017) and a validation set ( n = 384) at a ratio of 3:1. A prediction study was carried out using a competing risk model, where the event of interest was HCC and the competing events were death and liver transplantation, and subdistribution hazard ratios (sHRs) with 95% CIs were reported. The multivariate competing risk model was constructed and validated.

          Results

          There was a negligible difference between the original database and the 20 imputed datasets. At the end of follow-up, the median follow-up time was 69.9 months (interquartile range: 43.8–86.6). There were 31.5% (442/1401) of the patients who developed HCC, with a 5-year cumulative incidence of 22.9 (95%CI, 20.8%–25.2%). The univariate and multivariate competing risk regression and construction of the nomogram were performed in 20 imputed training datasets. Age, sex, antiviral therapy history, hepatitis B e antigen, alcohol drinking history, and alpha-fetoprotein levels were included in the nomogram. The area under receiver operating characteristic curve values at 12, 24, 36, 60, and 96 months were 0.68, 0.69, 0.70, 0.68, and 0.80, and the Brier scores were 0.30, 0.25, 0.23, 0.21, and 0.20 in the validation set. According to the cumulative incidence function, the nomogram effectively screened out high-risk HCC patients from low-risk patients in the presence of competing events (Fine–Gray test p < 0.001).

          Conclusion

          The competitive risk nomogram was allowed to be used for predicting HCC risk in individual patients with liver cirrhosis, taking into account both the association between risk factors and HCC and the modifying effect of competition events on this association.

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          mice: Multivariate Imputation by Chained Equations inR

          Stef van Buuren, Karin Groothuis-Oudshoorn (2011)
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            A Proportional Hazards Model for the Subdistribution of a Competing Risk

            Jason P. Fine, Robert J Gray (1999)
            Article 0 comments Cited 2409 times – based on 0 reviews     Review now
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              Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases

              Jorge A Marrero, Laura M Kulik, Claude Sirlin … (2018)
              Article 0 comments Cited 1561 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Dandan Guo: Role: Role: Role: Role: Role: Role: Role:
                Jianjun Li: URI : https://loop.frontiersin.org/people/1828343Role: Role: Role:
                Peng Zhao: Role: Role: Role:
                Tingting Mei: Role: Role: Role:
                Kang Li: URI : https://loop.frontiersin.org/people/1403992Role: Role:
                Yonghong Zhang: URI : https://loop.frontiersin.org/people/1897724Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 16 May 2024
                Publication date Collection: 2024
                Volume: 14
                Electronic Location Identifier: 1398968
                Affiliations
                [1] 1 Interventional Therapy Center for Oncology, Beijing You’An Hospital, Capital Medical University , Beijing, China
                [2] 2 Biomedical Information Center, Beijing You’An Hospital, Capital Medical University , Beijing, China
                [3] 3 Beijing Research Center for Respiratory Infectious Diseases , Beijing, China
                Author notes

                Edited by: Francisco Tustumi, University of São Paulo, Brazil

                Reviewed by: Terry Cheuk-Fung Yip, The Chinese University of Hong Kong, Hong Kong SAR, China

                Andras Perl, Upstate Medical University, United States

                Noha Kandil, Alexandria University, Egypt

                *Correspondence: Kang Li, bjyahlk@ 123456ccmu.edu.cn ; Yonghong Zhang, zhangyh@ 123456ccmu.edu.cn
                Article
                DOI: 10.3389/fonc.2024.1398968
                PMC ID: 11137271
                PubMed ID: 38817899
                SO-VID: caa30379-875f-4436-b045-7f3ffa48c9eb
                Copyright © Copyright © 2024 Guo, Li, Zhao, Mei, Li and Zhang
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 11 March 2024
                Date accepted : 24 April 2024
                Page count
                Figures: 6, Tables: 2, Equations: 0, References: 37, Pages: 11, Words: 5105
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by a grant Beijing research center for respiratory infectious diseases project (BJRID2024–007), the Beijing You’An Hospital (BJYAYY-YN2023–10) and Construction of research-oriented wards in Beijing municipality.
                Categories
                Subject: Oncology
                Subject: Original Research
                Custom metadata
                section-in-acceptance Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: hepatocellular carcinoma (hcc),competing risk,multiple imputation,prediction,hbv-related cirrhosis
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: hepatocellular carcinoma (hcc), competing risk, multiple imputation, prediction, hbv-related cirrhosis

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