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

StephenW

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

StephenW

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

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强调

    •开发了一种风险评分，用于预测亚洲慢性乙型肝炎患者在抗病毒治疗下的HCC。
    •修改后的PAGE-B评分需要有关年龄，性别，血小板计数和血清白蛋白水平的简便信息。
    •修正的PAGE-B评分显着区分5年HCC风险：低≤8和高≥13。

抽象
背景与目的

最近，开发了PAGE-B评分和多伦多HCC风险指数（THRI）来预测白种人慢性乙型肝炎（CHB）患者的肝细胞癌（HCC）风险。我们的目的是验证亚洲CHB患者的PAGE-B评分和THRI，并建议修改PAGE-B评分以增强预测性能。
方法

从2007年到2017年，我们检查了3,001名患有CHB的亚洲患者接受恩替卡韦/替诺福韦治疗。我们评估了PAGE-B，THRI，CU-HCC，GAG-HCC和REACH-B在HCC发展中的表现。基于多变量Cox模型开发了修改的PAGE-B得分（mPAGE-B）（推导集，n = 2,001）。进行了用于内部验证和外部验证（验证集，n = 1,000）的Bootstrap。
结果

恩替卡韦/替诺福韦治疗后，衍生和验证数据集中5年累积HCC发生率分别为6.5％和7.2％。在衍生数据集中，年龄，性别，血清白蛋白水平和血小板计数与HCC独立相关。 mPAGE-B评分是基于年龄，性别，血小板计数和白蛋白水平（接受者操作特征曲线下的时间依赖性区域[AUROC] = 0.82）开发的。在验证集中，PAGE-B和THRI在5年时显示出与CU-HCC，GAG-HCC和REACH-B相似的AUROCs（分别为0.72和0.73对0.70,0.71和0.61;除REACH外所有P> 0.05 -B），而5年时mPAGE-B的AUROC显着高于其他5个模型的0.82（均P <0.01）。在长期随访期间，所有风险组中CHB患者开始恩替卡韦/替诺福韦治疗后HCC发生率均显着下降。
结论

尽管PAGE-B和THRI适用于接受恩替卡韦/替诺福韦治疗的亚洲CHB患者，但包括额外白蛋白水平的mPAGE-B评分显示出比PAGE-B评分更好的预测性能。
放置摘要

在亚洲慢性乙型肝炎（CHB）患者中，本研究验证了PAGE-B评分和多伦多HCC风险指数，这些指标用于预测高效抗病毒治疗CHB患者的肝细胞癌（HCC）风险，并建议修改PAGE-B得分可以增强预测性能。改良的PAGE-B评分仅基于患者的年龄，性别，基线血小板计数和治疗开始时的血清白蛋白水平，代表了在抗病毒治疗的前5年预测HCC发展的可靠且易于获得的风险评分。在亚洲CHB患者中。评分范围为0到21分，修改后的PAGE-B评分可区分HCC风险。修正的PAGE-B评分显着区分5年HCC风险：低≤8分和高≥13分。
缩写：
AUROC（受试者工作特征曲线下面积），AST（天冬氨酸氨基转移酶），ALT（丙氨酸氨基转移酶），CHB（慢性乙型肝炎），CTP（Child-Turcotte-Pugh），CU-HCC（中国大学 - 肝细胞癌），ETV （恩替卡韦），GAG-HCC（年龄，性别，HBV DNA，核心启动子突变和肝硬化指南），HBeAg（乙型肝炎病毒包膜抗原），HBV DNA（乙型肝炎病毒脱氧核糖核酸），HCC（肝细胞癌），INR （国际标准化比率），MELD（终末期肝病模型），mPAGE-B（改良血小板，年龄，性别 - 乙型肝炎评分），NA（核苷（酸）类似物），REACH-B（风险评估）慢性乙型肝炎肝细胞癌，PAGE-B（血小板，年龄，性别 - 乙型肝炎评分），INR（凝血酶原时间的国际标准化比率），TDF（替诺福韦），THRI（多伦多HCC风险指数）
关键词：
慢性乙型肝炎，肝细胞癌，PAGE-B，风险预测模型