BACKGROUND & AIMS Current guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in all patients with cirrhosis, regardless of etiology. However, HCC incidence is not well established for many causes of cirrhosis. We aimed to assess the disease-specific incidence of HCC in a large cohort of patients with cirrhosis and to develop a scoring system to predict HCC risk. METHODS A derivation cohort of patients with cirrhosis diagnosed by biopsy or non-invasive measures was identified through retrospective chart review. The disease-specific incidence of HCC was calculated according to etiology of cirrhosis. Factors associated with HCC were identified through multivariable Cox regression and used to develop a scoring system to predict HCC risk. The scoring system was evaluated in an external cohort for validation. RESULTS Of 2,079 patients with cirrhosis and ≥6months follow-up, 226 (10.8%) developed HCC. The 10-year cumulative incidence of HCC varied by etiologic category from 22% in patients with viral hepatitis, to 16% in those with steatohepatitis and 5% in those with autoimmune liver disease (p<0.001). By multivariable Cox regression, age, sex, etiology and platelets were associated with HCC. Points were assigned in proportion to each hazard ratio to create the Toronto HCC Risk Index (THRI). The 10-year cumulative HCC incidence was 3%, 10% and 32% in the low-risk (<120points), medium-risk (120-240) and high-risk (>240) groups respectively, values that remained consistent after internal validation. External validation was performed on a cohort of patients with primary biliary cirrhosis, hepatitis B viral and hepatitis C viral cirrhosis (n=1,144), with similar predictive ability (Harrell's c statistic 0.77) in the validation and derivation cohorts. CONCLUSION HCC incidence varies markedly by etiology of cirrhosis. The THRI, using readily available clinical and laboratory parameters, has good predictive ability for HCC in patients with cirrhosis, and has been validated in an external cohort. This risk score may help to guide recommendations regarding HCC surveillance among patients with cirrhosis. LAY SUMMARY HCC incidence varies markedly depending on the underlying cause of cirrhosis. Herein, using readily available clinical and laboratory parameters we describe a risk score, THRI, which has a good predictive ability for HCC in patients with cirrhosis, and has been validated in an external cohort. This risk score may help to guide recommendations regarding HCC surveillance among patients with cirrhosis.

中文翻译：

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多伦多 HCC 风险指数：经过验证的评分系统可预测肝硬化患者 10 年 HCC 风险

背景和目的 目前的指南建议对所有肝硬化患者进行一年两次的肝细胞癌 (HCC) 监测，无论其病因如何。然而，对于肝硬化的许多原因，HCC 的发病率尚未确定。我们旨在评估一大群肝硬化患者中 HCC 的疾病特异性发病率，并开发一个评分系统来预测 HCC 风险。方法 通过回顾性图表审查确定了通过活检或非侵入性措施诊断的肝硬化患者的衍生队列。根据肝硬化的病因计算HCC的疾病特异性发病率。通过多变量 Cox 回归确定与 HCC 相关的因素，并用于开发预测 HCC 风险的评分系统。评分系统在外部队列中进行了评估以进行验证。结果 2, 079 例肝硬化患者随访 ≥6 个月，226 例（10.8%）发生 HCC。HCC 的 10 年累积发病率因病因类别而异，从病毒性肝炎患者的 22% 到脂肪性肝炎患者的 16% 和自身免疫性肝病患者的 5%（p<0.001）。通过多变量 Cox 回归，年龄、性别、病因和血小板与 HCC 相关。根据每个风险比按比例分配分数，以创建多伦多 HCC 风险指数 (THRI)。低风险 (<120 分)、中风险 (120-240) 和高风险 (>240) 组的 10 年累积 HCC 发病率分别为 3%、10% 和 32%，之后的值保持一致内部验证。对一组患有原发性胆汁性肝硬化、乙型肝炎病毒和丙型肝炎病毒性肝硬化的患者（n=1,144）进行了外部验证，在验证和推导队列中具有相似的预测能力（Harrell's c 统计量 0.77）。结论 HCC 发病率因肝硬化病因而异。THRI 使用现成的临床和实验室参数，对肝硬化患者的 HCC 具有良好的预测能力，并已在外部队列中得到验证。该风险评分可能有助于指导有关肝硬化患者 HCC 监测的建议。总结 HCC 发病率因肝硬化的根本原因而有显着差异。在此，我们使用现成的临床和实验室参数描述了风险评分 THRI，它对肝硬化患者的 HCC 具有良好的预测能力，并已在外部队列中得到验证。