慢性乙型肝炎肝细胞癌危险评分的临床应用

StephenW

Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B
Thodoris Voulgaris
Margarita Papatheodoridi
Pietro Lampertico
George V. Papatheodoridis
First published: 29 December 2019
https://doi.org/10.1111/liv.14334

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/liv.14334
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Abstract
Background

Several risk scores have been recently developed to predict hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients We systematically assessed the performance of the available HCC risk scores.
Methods

Literature search was performed to identify all published studies reporting development or external validation of HCC risk scores in CHB patients.
Results

Until March 2019, 12 scores were developed in untreated Asian and 7 scores in treated Asian (n=6) or Caucasian (n=1) patients. All scores provided significant predictions for HCC development in the derivation and validation cohorts of their original studies (c‐statistic:0.76‐0.95) and usually classified patients into low, medium and high HCC risk groups. Eleven independent studies and three studies developing their own scores have validated externally some scores in Asian (GAG‐HCC:5, CU‐HCC:6, REACH‐B:6, REACH‐Bm:4, LSM‐HCC:3, PAGE‐B:5) or Caucasian/mixed origin patients (GAG‐HCC:4, CU‐HCC:4, REACH‐B:4, PAGE‐B:2). All scores offered acceptable predictability in almost all independent Asian cohorts (c‐statistic:0.70‐0.86), but only PAGE‐B and recently mPAGE‐B offered good predictability in all independent Caucasian and/or Asian cohorts. Negative predictive values for 5‐year HCC prediction were ≤99% (95%‐99%) in most independent cohorts assessing Asian risk scores and 99%‐100% in all independent cohorts (Caucasian/mixed origin:2; Asian:3) assessing PAGE‐B and/or recently mPAGE‐B.
Conclusions

Direct comparison of the newest HCC risk scores in independent patient cohorts of different origin remains intriguing, although statistical associations may not be directly transferable to clinical practice. PAGE‐B and recently mPAGE‐B score seem to offer persistently high predictability for Caucasian and/or Asian treated patients with low HCC risk who require no surveillance.

StephenW

慢性乙型肝炎肝细胞癌危险评分的临床应用
Thodoris寻常
玛格丽塔（Margarita Papatheodoridi）
Pietro Lampertico
乔治五世·帕帕特奥多里迪斯
首次发布：2019年12月29日
https://doi.org/10.1111/liv.14334

本文已被接受发表并接受了完整的同行评审，但尚未经过复制编辑，排版，分页和校对过程，这可能会导致此版本与“记录版本”之间存在差异。请引用本文作为doi：10.1111 / liv.14334
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背景

最近已经开发了几种风险评分来预测慢性乙型肝炎（CHB）患者的肝细胞癌（HCC）。我们系统地评估了可用HCC风险评分的表现。
方法

进行文献检索，以鉴定所有已发表的报道CHB患者HCC风险评分的发展或外部验证的研究。
结果

直到2019年3月，未经治疗的亚洲人获得了12分，经过治疗的亚洲人（n = 6）或白种人（n = 1）患者获得了7分。所有分数均在其原始研究的派生和验证队列中提供了重要的肝癌发展预测（c统计量：0.76-0.95），并且通常将患者分为低，中和高HCC风险组。 11项独立研究和3项发展自己得分的研究在外部验证了亚洲的部分得分（GAG-HCC：5，CU-HCC：6，REACH-B：6，REACH-Bm：4，LSM-HCC：3，PAGE- B：5）或高加索/混合血统患者（GAG-HCC：4，CU-HCC：4，REACH-B：4，PAGE-B：2）。在几乎所有独立的亚洲人群中，所有分数均提供了可接受的可预测性（c统计：0.70-0.86），但只有PAGE-B和最近的mPAGE-B在所有独立的白种人和/或亚洲人群中均具有良好的可预测性。在大多数评估亚洲风险评分的独立人群中，对5年HCC预测的阴性预测值为≤99％（95％-99％），在所有独立人群中均为99％-100％（白种人/混合血统：2；亚洲人：3）评估PAGE-B和/或最近的mPAGE-B。
结论

尽管统计关联可能无法直接转移到临床实践中，但是对不同来源的独立患者队列中最新HCC风险评分的直接比较仍然很有趣。 PAGE-B评分和最近的mPAGE-B评分似乎为不需要监测的高HCC风险的高加索人和/或亚洲人接受治疗的患者提供了持续较高的可预测性。

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/liv.14334