重新评估PAGE-B相关评分的准确性，以预测慢性乙型肝炎患者

StephenW

J Hepatol. 2019 Dec 16. pii: S0168-8278(19)30717-2. doi: 10.1016/j.jhep.2019.12.005. [Epub ahead of print]
Reassessing the accuracy of PAGE-B-related scores to predict hepatocellular carcinoma development in patients with chronic hepatitis B.
Cheuk-Fung Yip T1, Lai-Hung Wong G2, Wai-Sun Wong V2, Tse YK1, Liang LY1, Wing-Ki Hui V1, Lee HW3, Chung-Yan Lui G4, Lik-Yuen Chan H5.
Author information

1
    Institute of Digestive Disease,; Department of Medicine and Therapeutics.
2
    Institute of Digestive Disease,; Department of Medicine and Therapeutics; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China.
3
    Institute of Digestive Disease,; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
4
    Department of Medicine and Therapeutics.
5
    Institute of Digestive Disease,; Department of Medicine and Therapeutics; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China. Electronic address: [email protected].

Abstract
BACKGROUND & AIMS:

PAGE-B and modified PAGE-B (mPAGE-B) scores are developed to predict risk of hepatocellular carcinoma (HCC) in patients on nucleos(t)ide analogue therapy. However, how and when to use these risk scores in clinical practice is uncertain.
METHODS:

Consecutive adult patients with chronic hepatitis B who had received entecavir or tenofovir for at least 6 months between January 2005 and June 2018 were identified from a territory-wide database in Hong Kong. Performance of PAGE-B and mPAGE-B scores on HCC prediction at 5 years was assessed by area under the time-dependent receiver operating characteristic curve (AUROC), and different cut-off values of these two scores were evaluated by survival analysis.
RESULTS:

Of 32,150 identified chronic hepatitis B patients, 20,868 (64.9%) were male. Their mean age was 53.0±13.2 years. At a median (interquartile range) follow-up of 3.9 (1.8-5.0) years, 1,532 (4.8%) patients developed HCC. The AUROC (95% confidence interval [CI]) of PAGE-B and mPAGE-B scores to predict HCC at 5 years was 0.77 (0.76-0.78) and 0.80 (0.79-0.81), respectively (P<0.001). 9,417 (29.3%) patients were classified as low HCC risk by either PAGE-B or mPAGE-B scores; their 5-year cumulative incidence (95% CI) of HCC was 0.6% (0.4%-0.8%). This classification achieved a negative predictive value (95% CI) of 99.5% (99.4%-99.7%) to exclude patients without HCC development in five years. The AUROC of PAGE-B and mPAGE-B scores at baseline and 2-year on-treatment to predict HCC were similar.
CONCLUSIONS:

PAGE-B and mPAGE-B scores can be applied to identify patients who have low risk of HCC development on antiviral therapy. These patients may be considered exemption from HCC surveillance due to their very low HCC risk.

Copyright © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
KEYWORDS:

Entecavir; liver cancer; nucleos(t)ide analogues; risk score; tenofovir

PMID:
    31857194
DOI:
    10.1016/j.jhep.2019.12.005

StephenW

J肝素。 2019年12月16日.pii：S0168-8278（19）30717-2。 doi：10.1016 / j.jhep.2019.12.005。 [Epub提前发布]
重新评估PAGE-B相关评分的准确性，以预测慢性乙型肝炎患者肝细胞癌的发展。
叶uk峰T1，黄丽红G2，黄伟新V2，谢YK1，梁LY1，许永基V1，李宏伟3，吕中仁G4，李力源H5。
作者信息

1个
    消化疾病研究所；医学与治疗学系。
2
    消化疾病研究所；医学与治疗学系;香港中文大学消化系统疾病国家重点实验室；中国香港特别行政区。
3
    消化疾病研究所；延世大学医学院内科，韩国首尔。
4
    医学与治疗学系。
5
    消化疾病研究所；医学与治疗学系;香港中文大学消化系统疾病国家重点实验室；中国香港特别行政区。电子地址：[email protected]。

抽象
背景与目的：

PAGE-B和修改后的PAGE-B（mPAGE-B）分数可预测使用核苷酸类似物治疗的患者的肝细胞癌（HCC）风险。但是，在临床实践中如何以及何时使用这些风险评分尚不确定。
方法：

从2005年1月至2018年6月，至少连续6个月接受恩替卡韦或替诺福韦治疗的连续性慢性乙型肝炎成人患者来自香港全域数据库。 PAGE-B和mPAGE-B评分在5年时对HCC预测的表现通过时间依赖性受体工作特征曲线（AUROC）下的面积进行评估，并且通过生存分析评估这两个评分的不同临界值。
结果：

在确定的32,150例慢性乙型肝炎患者中，男性为2​​0,868（64.9％）。他们的平均年龄是53.0±13.2岁。在3.9（1.8-5.0）年的中位（四分位间距）随访中，有1,532（4.8％）例患者发生了HCC。 PAGE-B和mPAGE-B评分的5年预测HCC的AUROC（95％置信区间[CI]）分别为0.77（0.76-0.78）和0.80（0.79-0.81）（P <0.001）。 PAGE-B或mPAGE-B评分将9,417（29.3％）位患者归为低HCC风险；他们的5年肝癌累积发生率（95％CI）为0.6％（0.4％-0.8％）。该分类实现了59.5％的阴性预测值（95％CI）为99.5％（99.4％-99.7％），以排除没有HCC发生的患者。基线和治疗2年时预测肝癌的PAGE-B和mPAGE-B得分的AUROC相似。
结论：

PAGE-B和mPAGE-B评分可用于鉴定抗病毒治疗的HCC发生风险低的患者。这些患者由于其极低的HCC风险可被视为免于HCC监测。

版权所有©2019欧洲肝脏研究协会。由Elsevier B.V.发布。保留所有权利。
关键字：

恩替卡韦;肝癌;核苷（核苷酸）类似物;风险评分；替诺福韦

PMID：
    31857194
DOI：  10.1016 / j.jhep.2019.12.005