A Liver Stiffness-Based Etiology-Independent Machine Learning Algorithm to Predict Hepatocellular Carcinoma

Clin Gastroenterol Hepatol. 2024 Mar;22(3):602-610.e7. doi: 10.1016/j.cgh.2023.11.005. Epub 2023 Nov 21.

Abstract

Background & aims: The existing hepatocellular carcinoma (HCC) risk scores have modest accuracy, and most are specific to chronic hepatitis B infection. In this study, we developed and validated a liver stiffness-based machine learning algorithm (ML) for prediction and risk stratification of HCC in various chronic liver diseases (CLDs).

Methods: MLs were trained for prediction of HCC in 5155 adult patients with various CLDs in Korea and further tested in 2 prospective cohorts from Hong Kong (HK) (N = 2732) and Europe (N = 2384). Model performance was assessed according to Harrell's C-index and time-dependent receiver operating characteristic (ROC) curve.

Results: We developed the SMART-HCC score, a liver stiffness-based ML HCC risk score, with liver stiffness measurement ranked as the most important among 9 clinical features. The Harrell's C-index of the SMART-HCC score in HK and Europe validation cohorts were 0.89 (95% confidence interval, 0.85-0.92) and 0.91 (95% confidence interval, 0.87-0.95), respectively. The area under ROC curves of the SMART-HCC score for HCC in 5 years was ≥0.89 in both validation cohorts. The performance of SMART-HCC score was significantly better than existing HCC risk scores including aMAP score, Toronto HCC risk index, and 7 hepatitis B-related risk scores. Using dual cutoffs of 0.043 and 0.080, the annual HCC incidence was 0.09%-0.11% for low-risk group and 2.54%-4.64% for high-risk group in the HK and Europe validation cohorts.

Conclusions: The SMART-HCC score is a useful machine learning-based tool for clinicians to stratify HCC risk in patients with CLDs.

Keywords: Artificial Intelligence; Cirrhosis; Liver Cancer; Liver Fibrosis; Transient Elastography.

MeSH terms

  • Adult
  • Algorithms
  • Antiviral Agents / therapeutic use
  • Carcinoma, Hepatocellular* / epidemiology
  • Hepatitis B* / complications
  • Hepatitis B, Chronic* / drug therapy
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / drug therapy
  • Liver Neoplasms* / epidemiology
  • Machine Learning
  • Prospective Studies
  • Risk Factors

Substances

  • Antiviral Agents