Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy
Ji Hyun Kima
, Young Don Kima
, Minjong Lee'Correspondence information about the author Minjong LeeEmail the author Minjong Lee
, Baek Gyu Jun
, Tae Suk Kim
, Ki Tae Suk
, Seonghee Kang
, Moon Young Kim
, Gab Jin Cheon
, Dong Joon Kim
, Soon Koo Baik
, Dae Hee Choi'Correspondence information about the author Dae Hee ChoiEmail the author Dae Hee Choi
PlumX Metrics
DOI: https://doi.org/10.1016/j.jhep.2018.07.018
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Highlights
•A risk score was developed that predicted HCC in Asian patients with chronic hepatitis B under antiviral therapy.
•Modified PAGE-B scores required easily available information on age, gender, platelet counts, and serum albumin levels.
•Modified PAGE-B scores significantly differentiated the 5-year HCC risk: low ≤ 8 and high ≥ 13.
Abstract
Background & Aims
Recently, PAGE-B score and Toronto HCC risk index (THRI) have been developed to predict the risk of hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB). We aimed to validate PAGE-B scores and THRI in Asian patients with CHB and suggested modified PAGE-B scores to potentiate the predictive performance.
Methods
From 2007 to 2017, we examined 3,001 Asian patients with CHB receiving entecavir/tenofovir therapy. We assessed the performances of PAGE-B, THRI, CU-HCC, GAG-HCC, and REACH-B for HCC development. A modified PAGE-B score (mPAGE-B) was developed (derivation set, n=2,001) based on multivariable Cox models. Bootstrap for internal validation and external validation (validation set, n=1,000) were performed.
Results
The 5-year cumulative HCC incidence rates were 6.5% and 7.2% in the derivation and validation datasets after entecavir/tenofovir onset. In the derivation dataset, age, gender, serum albumin levels, and platelet counts were independently associated with HCC. The mPAGE-B score was developed based on age, gender, platelet counts, and albumin levels (time-dependent area under receiver operating characteristic curves [AUROC]=0.82). In the validation set, the PAGE-B and THRI showed similar AUROCs to CU-HCC, GAG-HCC, and REACH-B at 5 years (0.72 and 0.73 vs. 0.70, 0.71, and 0.61 respectively; all P>0.05 except REACH-B), whereas the AUROC of mPAGE-B at 5 years was 0.82 significantly higher than the five other models (all P<0.01). HCC incidence rates after entecavir/tenofovir therapy initiation in CHB patients were significantly decreased in all risk groups in long-term follow-up periods.
Conclusion
Although PAGE-B and THRI are applicable in Asian CHB patients receiving entecavir/tenofovir therapy, mPAGE-B scores including additional albumin levels showed better predictive performance than the PAGE-B score.
Lay summary
In Asian patients with chronic hepatitis B (CHB), this study validated PAGE-B scores and Toronto HCC risk index that were developed to predict the risk of hepatocellular carcinoma (HCC) in Caucasian patients with CHB under potent antiviral therapy, and suggested that modified PAGE-B scores could potentiate predictive performance. A modified PAGE-B score, which is based only on a patient’s age, gender, baseline platelet counts, and serum albumin levels at treatment initiation, represents a reliable and easily available risk score to predict HCC development during the first 5 years of antiviral treatment in Asian patients with CHB. With a scoring range from 0 to 21 points, a modified PAGE-B score differentiates the HCC risk. A modified PAGE-B score significantly differentiates the 5-year HCC risk: low ≤8 points and high ≥13 points.
Abbreviations:
AUROC (area under receiver operating characteristics curve), AST (aspartate aminotransferase), ALT (alanine aminotransferase), CHB (chronic hepatitis B), CTP (Child-Turcotte-Pugh), CU-HCC (Chinese university-hepatocellular carcinoma), ETV (entecavir), GAG-HCC (guide with age, gender, HBV DNA, core promoter mutations and cirrhosis), HBeAg (hepatitis B virus envelope antigen), HBV DNA (hepatitis B virus deoxyribonucleic acid), HCC (hepatocellular carcinoma), INR (international normalized ratio), MELD (model for end-stage liver disease), mPAGE-B (modified platelets, age, gender-hepatitis B scores), NA (nucleos(t)ide analog), REACH-B (risk estimation for hepatocellular carcinoma in chronic hepatitis B), PAGE-B (platelets, age, gender-hepatitis B scores), INR (international normalized ratio for prothrombin time), TDF (tenofovir), THRI (Toronto HCC risk index)
Keywords:
Chronic hepatitis B, Hepatocellular carcinoma, PAGE-B, Risk prediction model作者: StephenW 时间: 2018-8-3 15:49
修改后的PAGE-B评分可预测亚洲人慢性乙型肝炎抗病毒治疗后肝细胞癌的风险
吉贤基马
，年轻的唐基马
，Minjong Lee'关于作者Minjong LeeEmail的作者Minjong Lee的相关信息
，Baek Gyu Jun
，Tae Suk Kim
，Ki Tae Suk
，Seonghee Kang
，Moon Young Kim
，Gab Jin Cheon
，Dong Joon Kim
很快Koo Baik
，Dae Hee Choi关于作者Dae Hee Choi的相关信息电子邮件作者Dae Hee Choi
PlumX度量标准
DOI：https：//doi.org/10.1016/j.jhep.2018.07.018