Comparative performance of HCC risk scores in identifying low-risk patients with cirrhosis: A multicenter cohort study.

Authors

Mohamed Moussa, Koos de Wit, Lubbertus C Baak, Dave Sprengers, Raoel Maan, Adriaan J van der Meer, Stan van Wijk, Emma Kleij, Roy S Dwarkasing, Willem Pieter Brouwer, Femme Dirksmeier-Harinck, Jordan J Feld, Harry L A Janssen, R Bart Takkenberg, Milan J Sonneveld

Published in

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. Sep 02, 2026. Epub Sep 02, 2026.

Abstract

The rising prevalence of cirrhosis, driven by non-viral etiologies, strains healthcare systems and necessitates personalized hepatocellular carcinoma (HCC) surveillance. We conducted a head-to-head comparison of the Toronto HCC risk index (THRI) and aMAP score within an etiology-diverse Western population to evaluate their performance in identifying low-risk patients.
We included adults with cirrhosis from 3 sites in the Netherlands. The exclusion criteria were follow-up <6 months, missing risk score data, or prior HCC. THRI and aMAP were calculated as previously reported. Performance was assessed using time-dependent AUC analysis and cumulative HCC incidence using Kaplan-Meier analysis.
In a cohort of 1531 patients, the median age was 53 years (IQR: 44-61), 63% were male, the median CTP was 5 (IQR: 5-7). The etiology of liver disease was non-viral in 60% of patients, with the majority having steatotic liver disease (SLD: 453, 30%). Over a median follow-up of 5.4 years (IQR: 3.0-9.1), 196 patients developed HCC. Overall 5-year cumulative HCC incidence was 7.2% (95%CI: 5.7-8.7). THRI offered superior discrimination over aMAP at 3 years (AUC 0.74 vs 0.64) and at 5 years (0.73 versus 0.70). Patients identified by THRI as low-risk (n = 269, 18%) had a lower 5-year risk of HCC (0.5%) than those identified as low risk by aMAP (2.9%). Among the patients considered low-risk by aMAP (n = 437), two-thirds were assigned a higher risk category by THRI and had a substantially higher 5-year HCC incidence than low-risk THRI and low-risk aMAP (4.3%vs. 0%, p = 0.009).
THRI appears more effective than aMAP in identifying patients with negligible 5-year HCC risk and may inform personalized HCC surveillance strategies, particularly in supporting deferral decisions in low-risk patients.

PMID:
42686444
Bibliographic data and abstract were imported from PubMed on 03 Sep 2026.

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