Modified PAGE-B score predicts the risk of hepatocellular carcinoma in Asians with chronic hepatitis B on antiviral therapy
Ji Hyun Kim†
, Young Don Kim†
, Minjong Lee'Correspondence information about the author Minjong LeeEmail the author Minjong Lee
, Baek Gyu Jun
, Tae Suk Kim
, Ki Tae Suk
, Seong Hee 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
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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.
Background & Aims
Recently, the 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 improve 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 five-year cumulative HCC incidence rates were 6.6% 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 serum 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 five 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 five years was 0.82, significantly higher than the five other models (all p <0.01). HCC incidence rates after initiation of entecavir/tenofovir therapy in patients with CHB were significantly decreased in all risk groups in long-term follow-up periods.
Conclusion
Although PAGE-B and THRI are applicable in Asian patients with CHB receiving entecavir/tenofovir therapy, mPAGE-B scores including additional serum albumin levels showed better predictive performance than the PAGE-B score.
Lay summary
PAGE-B scores and Toronto HCC risk index were developed to predict the risk of hepatocellular carcinoma (HCC) in Caucasian patients with CHB under potent antiviral therapy. This study validated these two scores in Asian patients with CHB and suggested that modified PAGE-B scores could improve the 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 five 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 five-year HCC risk: low ≤8 points and high ≥13 points.
Keywords:
Chronic hepatitis B, Hepatocellular carcinoma, PAGE-B, Risk prediction mode作者: StephenW 时间: 2018-10-17 09:44
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
Ji Hyun Kim†
，年轻的唐金†
，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
，Seong Hee 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
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DOI：https：//doi.org/10.1016/j.jhep.2018.07.018 |
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