High-risk amap scores are present in a majority of hepatocellular carcinoma (hcc) patients not undergoing prior routine ultrasound-based screening, at both one and five years before hcc diagnosis

Introduction aMAP score (using age, gender, albumin and bilirubin levels, platelet count) can predict HCC risk in chronic liver disease [Fan R et al, J Hepatol 2020]. We have previously shown high-risk aMAP scores detectable in an unselected UK population, up to 5 years prior to HCC diagnosis. Unfortunately, many patients are diagnosed with HCC outside of ultrasound (US) screening programmes. Here we look at historical aMAP scores in patient groups of HCC related to Non-alcoholic Fatty Liver Disease (NAFLD) and Chronic Hepatitis B (HBV) or C (HCV), where these patients had not been under US-based HCC screening. Methods We calculated aMAP scores from 36 HCC patients at 1 year pre-diagnosis, where 22 had underlying NAFLD and 14 had Chronic HBV or HCV. We assessed differences in high-risk (> or = 60), medium-risk (50–59) or low-risk (<50) scores between the groups. We also studied high-risk score prevalence in 24 HCC patients (15 NAFLD-related and 9 HBV/HCV-related) at 5-years prior to HCC diagnosis. Results In the NAFLD-HCC group, at 1-year pre-HCC, 16 (72.7%) of 22 patients had high-risk scores while the remaining 6 (27.3%) patients had medium-risk scores. In the HBV/HCV-related HCC group, 9 (64.3%) patients had high-risk scores while the remaining 5 (35.7%) patients had medium-risk scores. Using Fisher’s exact test, there was no statistically significant difference (p=0.71) in high-risk score prevalence between the two groups. At 5-years pre-HCC, 10 (66.7%) out of 15 patients with underlying NAFLD had high-risk scores and the remaining 5 (33.3%) patients had low-risk scores. At the same timepoint, 5 (55.5%) out of 9 patients from the HBV/HCV group had high-risk scores while 4 (44.5%) patients had medium-risk scores. No statistically significant difference existed between the two groups with regards to high-risk score prevalence (p=0.68, Fisher’s exact test) We noted zero prevalence of low-risk aMAP scores in all patients at all timepoints. Discussion Our data suggests that aMAP scores may be useful in HCC risk-stratification in patients with liver disease where US-based screening is not possible or not currently recommended. High-risk aMAP scores may also potentially guide use of US-based HCC surveillance in patients who would not normally meet criteria for imaging-based surveillance.