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 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
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.

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

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
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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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。

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评分以提高预测性能。
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对HCC发展的表现。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

在恩替卡韦/替诺福韦治疗后的衍生和验证数据集中，五年累积HCC发病率分别为6.6％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，血小板计数和血清白蛋白水平（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类似的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为0.82，显着高于其他5个模型（均p <0.01）。在长期随访期间，所有风险组中CHB患者开始接受恩替卡韦/替诺福韦治疗后的HCC发生率均显着降低。
结论

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

开发了PAGE-B评分和多伦多HCC风险指数，以预测高效抗病毒治疗的白种人CHB患者的肝细胞癌（HCC）风险。本研究验证了亚洲CHB患者的这两项评分，并提出改良的PAGE-B评分可以提高预测性能。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五年预测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。改良的PAGE-B评分显着区分五年HCC风险：低≤8分和高≥13分。
关键词：
慢性乙型肝炎，肝细胞癌，PAGE-B，风险预测模式

桦子

请问StephenW:
mPAGE-B评分公式=?
谢谢！

StephenW

回复 桦子 的帖子

从论文中提取

Table 3.  Construction of  Modified  PAGE-B  risk  scores  for  prediction of  HCC in Asian
chronic hepatitis B patients under entecavir or tenofovir   
Age (years)      Gender        Platelets (×10**9/L)  Albumin (g/dL)
<    30: 0         Female  : 0   ≥ 250:     0               ≥ 4.0:   0
30–39: 3         Male:       2   200–250: 2              3.5–4.0: 1
40–49: 5                            150–200: 3               3–3.5:    2
50–59: 7                            100–150: 4              < 3:        3
60–69: 9                            < 100:     5                  
≥   70: 11

桦子

表3.用于预测亚洲人HCC的修正PAGE-B风险评分的构建
  恩替卡韦或替诺福韦治疗慢性乙型肝炎患者
  年龄（岁）性别血小板（×10 ** 9 / L）白蛋白（g / dL）
  <30：0女性：0≥250：0≥4.0：0
  30-39：3男：2 200-250：2 3.5-4.0：1
  40-49：5 150-200：3 3-3.5：2
  50-59：7 100-150：4 <3：3
  60-69：9 <100：5
  ≥70：11