Background: Most liver cancer scoring systems focus on patients with preexisting liver diseases such as chronic viral hepatitis or liver cirrhosis. Patients with diabetes are at higher risk of developing liver cancer than the general population. However, liver cancer scoring systems for patients in the absence of liver diseases or those with diabetes remain rare. This study aims to develop a risk scoring system for liver cancer prediction among diabetes patients and a sub-model among diabetes patients without cirrhosis/chronic viral hepatitis. Methods: A retrospective cohort study was performed using electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. The outcome was diagnosis of liver cancer during follow-up. A risk scoring system was developed by applying random survival forest in variable selection, and Cox regression in weight assignment. Results: The liver cancer incidence was 0.92 per 1000 person-years. Patients who developed liver cancer (n= 1995) and those who remained free of cancer (n= 1969) during follow-up (median: 6.2 years) were selected for model building. In the final time-to-event scoring system, presence of chronic hepatitis B/C, alanine aminotransferase, age, presence of cirrhosis, and sex were included as predictors. The concordance index was 0.706 (95%CI: 0.676–0.741). In the sub-model for patients without cirrhosis/chronic viral hepatitis, alanine aminotransferase, age, triglycerides, and sex were selected as predictors. Conclusions: The proposed scoring system may provide a parsimonious score for liver cancer risk prediction among diabetes patients.
背景：多数肝癌评分系统主要针对已存在慢性病毒性肝炎或肝硬化等肝脏疾病的患者。糖尿病患者发生肝癌的风险高于普通人群，但目前针对无肝脏疾病或糖尿病患者群体的肝癌评分系统仍较为缺乏。本研究旨在建立适用于糖尿病患者的肝癌风险预测评分系统，并针对无肝硬化/慢性病毒性肝炎的糖尿病患者构建亚组模型。 方法：本研究采用香港电子健康记录进行回顾性队列分析。纳入2010年至2019年间在普通门诊接受糖尿病治疗且无癌症病史的患者，随访至2019年12月。研究终点为随访期间确诊肝癌。通过随机生存森林法进行变量筛选，并采用Cox回归模型进行权重分配，构建风险评分系统。 结果：肝癌发病率为每1000人年0.92例。在随访期间（中位时间6.2年），共纳入发生肝癌患者（n=1995）与未患癌患者（n=1969）进行模型构建。最终构建的时序事件评分系统包含慢性乙型/丙型肝炎感染状态、丙氨酸氨基转移酶水平、年龄、肝硬化状态及性别等预测因子，一致性指数为0.706（95%CI：0.676-0.741）。在无肝硬化/慢性病毒性肝炎患者的亚组模型中，丙氨酸氨基转移酶、年龄、甘油三酯及性别被选为预测因子。 结论：本研究提出的评分系统可为糖尿病患者提供简明的肝癌风险预测工具。
肿瘤(癌症)患者之家