Evaluating the Predictive Value of Clinical Models for HBV-Related Hepatocellular Carcinoma: A Meta-Analysis

Long Huang ¹ Lu-Huai Feng ¹ Yang Lu ¹ Bobin Hu ¹ Hongqian Liang ¹ Aoli Ren ¹ Hang Wang ¹ Wenming He ¹ Caifang Deng ¹ Minghua Su ^1* Jianning Jiang ^1,2,3*

• ¹ First Affiliated Hospital, Guangxi Medical University, Nanning, China
• ² Ministry of Education Key Laboratory of Regional High Incidence Cancer Early Prevention Research, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
• ³ Key Laboratory of Early Prevention and Treatment of Regional High-incidence Tumors, Ministry of Education Key Laboratory,Guangxi Medical University, Nanning, Guangxi Zhuang Region, China

Objectives: Chronic viral hepatitis B (CHB) is a prevalent liver disease with primary hepatic carcinoma (HCC) as a severe complication. Clinical prediction models have gained attention for predicting HBV-related HCC (HBV-HCC). This study aimed to evaluate the predictive value of existing models for HBV-HCC through meta-analysis.Design: Meta-analysis.Data sources: Embase, PubMed, the Chinese Biomedical Literature Service System, and the Cochrane database were used for searches between 1970 and 2022.Method: A meta-analysis was conducted to assess original studies on HBV-HCC prediction models. The REACH-B, GAGHCC, and CUHCC models were externally validated in a Guangxi cohort. The C-index and calibration curve evaluated 5-year predictive performance, with subgroup analysis by region and risk bias.Results: After screening, 27 research articles were included, covering the GAGHCC, REACH-B, PAGE-B, CU-HCC, CAMD, and mPAGE-B models. The meta-analysis indicated that these models had moderate discrimination in predicting HCC risk in HBV-infected patients, with C-index values from 0.75 to 0.82. The mPAGE-B (0.79, 95% CI: 0.79-0.80), GAG-HCC (0.80, 95% CI: 0.78-0.82), and CAMD (0.80, 95% CI: 0.78-0.81) models demonstrated better discrimination than others (P < 0.05), but most studies did not report model calibration. Subgroup analysis suggested that ethnicity and research bias might contribute to differences in model discrimination. Sensitivity analysis indicated stable meta-analysis results. The REACH-B, GAGHCC, CUHCC, PAGE-B, and mPAGE-B models had average predictive performance in Guangxi, with medium to low 3-year and 5-year HCC risk prediction discrimination.Conclusions: Existing models have predictive value for HBV-infected patients but show geographical limitations and reduced effectiveness in Guangxi.