한빛사 논문
Hwi Young Kim MD, PhD1,∗, Pietro Lampertico MD, PhD2,3,∗, Joon Yeul Nam MD4,∗, Hyung-Chul Lee MD, PhD5,∗, Seung Up Kim MD, PhD6, Dong Hyun Sinn MD, PhD7, Yeon Seok Seo MD, PhD8, Han Ah Lee MD, PhD8,9, Soo Young Park MD, PhD10, Young-Suk Lim MD, PhD11, Eun Sun Jang MD, PhD12, Eileen L. Yoon MD, PhD9,13, Hyoung Su Kim MD, PhD14, Sung Eun Kim MD, PhD15, Sang Bong Ahn MD, PhD16, Jae-Jun Shim MD, PhD17, Soung Won Jeong MD, PhD18, Yong Jin Jung MD, PhD19, Joo Hyun Sohn MD, PhD20, Yong Kyun Cho MD, PhD21, Dae Won Jun MD, PhD13, George N. Dalekos MD, PhD22, Ramazan Idilman MD, PhD23, Vana Sypsa MD, PhD24, Thomas Berg MD, PhD25, Maria Buti MD, PhD26, Jose Luis Calleja MD, PhD27, John Goulis MD, PhD28, Spilios Manolakopoulos MD, PhD29, Harry LA. Janssen MD, PhD30, Myoung-jin Jang MD, PhD31, Yun Bin Lee MD, PhD4, Yoon Jun Kim MD, PhD4, Jung-Hwan Yoon MD, PhD4, George V. Papatheodoridis MD, PhD32,∗∗, Jeong-Hoon Lee MD, PhD4,∗∗
1Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
2Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
3CRC “A. M. and A. Migliavacca” Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
4Department of Internal Medicine and Liver Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea;
5Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Republic of Korea
6Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
7Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
8Department of Internal Medicine, Korea University Anam Hospital, Korea University College
9Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
10Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
11Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea
12Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
13Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
14Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
15Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
16Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
17Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
18Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
19Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center
20Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Republic of Korea
21Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
22Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
23Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
24Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
25Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
26Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
27Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain
284th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, General Hospital of Thessaloniki “Hippokratio”, Thessaloniki, Greece
292nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
30Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
31Medical Research Collaboration Center, Seoul National University Hospital, Seoul, Republic of Korea
32Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
∗These four authors contributed equally to this work as co-first authors.
∗∗These two authors contributed equally to this work as co-corresponding authors.
Abstract
Background & Aims
Several risk models were recently developed to predict risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Our aims were to develop and validate an artificial intelligence-assisted prediction model of HCC risk.
Methods
Using a gradient-boosting machine (GBM) algorithm, a model was developed using 6,051 patients with CHB who received entecavir or tenofovir therapy from four hospitals in Korea. Two external validation cohorts were independently established: Korean (5,817 patients from 14 Korean centers) and Caucasian (1,640 from 11 Western centers) PAGE-B cohorts. The primary outcome was HCC development.
Results
In the derivation cohort and the two validation cohorts, cirrhosis was present in 26.9%–50.2% of patients at baseline. A model using 10 parameters at baseline was derived and showed good prediction performance [concordance index (c-index), 0.79]. This model showed significantly better discrimination than previous models (PAGE-B, modified PAGE-B, REACH-B, and CU-HCC) in both the Korean (c-index, 0.79 vs. 0.64–0.74; all P < 0.001) and Caucasian validation cohorts [c-index, 0.81 vs. 0.57–0.79; all P < 0.05 except modified PAGE-B (P = 0.22)]. A calibration plot showed a satisfactory calibration function. When the patients were grouped into four risk groups, the minimal-risk group (11.2% of the Korean cohort and 8.8% of the Caucasian cohort) had a less than 0.5% risk of HCC during 8 years of follow-up.
Conclusions
This GBM-based model provides the best predictive power for HCC risk in Korean and Caucasian patients with CHB treated with entecavir or tenofovir.
Lay summary
Risk scores have been developed to predict the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. We developed and validated a new risk prediction model using machine learning algorithms in 13,508 antiviral-treated patients with chronic hepatitis B. Our new model, based on 10 common baseline characteristics, demonstrated superior performance in risk stratification compared with previous risk scores. This model also identified a group of patients at minimal risk of developing HCC, who could be indicated for less intensive HCC surveillance.
Keywords : liver cancer, deep neural networking, antiviral treatment
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