Enhanced Prediction of Hepatitis B Virus-Related Hepatocellular Carcinoma Using Age-male-albumin-bilirubin-platelet (aMAP) and Liver Stiffness Assessed by Vibration-controlled Transient Elastography

Abstract

Background & Aims The feasibility of age-male-albumin-bilirubin-platelet (aMAP) score combined with liver stiffness (LS) measurement in predicting hepatocellular carcinoma (HCC) risk remains unexplored. This study evaluated the performance of combining the aMAP score with LS measurements for HCC prediction in patients with chronic hepatitis B (CHB). Methods We analyzed 944 patients with CHB who initiated antiviral therapy between May 2005 and July 2021 at 5 tertiary hospitals in Korea. The predictive accuracy of aMAP alone, and aMAP combined with LS for advanced fibrosis (aMLaf), and aMAP combined with LS for cirrhosis (aMLc) was assessed. External validation was conducted using Hong Kong cohort. Results During a median follow-up of 68.9 months, 49 patients developed HCC, and their aMAP was significantly higher than that of the patients who did not develop HCC. The aMLaf and aMLc models demonstrated superior predictive performance compared with conventional models, with areas under the receiver operating characteristic curve (AUROCs) at 5 years of 0.82 and 0.82, respectively (both P < .05 vs PAGE-B and modified PAGE-B). In multivariate analysis, elevated aMAP (hazard ratio [HR], 1.16l 95% confidence interval [CI], 1.09–1.24), aMLaf (HR, 1.08; 95% CI, 1.03–1.13), and aMLc (HR, 1.06; 95% CI, 1.03–1.09) were independent predictors for HCC development. Notably, no HCC cases occurred in the aMLaf low-risk group during follow-up. External validation in the Hong Kong cohort confirmed the robustness of aMLaf and aMLc, with Harrell’s c-index and iAUC values above 0.80. Conclusion The integration of aMAP score with LS measurements significantly improved HCC risk prediction in patients with CHB receiving antiviral therapy. This combined model may enable more precise risk stratification and personalized surveillance strategies. © 2025 AGA Institute.