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

Reassessing the accuracy of PAGE-B-related scores to predict hepatocellular carcinoma development in patients with chronic hepatitis B [url=]Terry Cheuk-Fung Yip[/url]1,2
,  [url=]Grace Lai-Hung Wong[/url]1,2,3
,  [url=]Vincent Wai-Sun Wong[/url]1,2,3
,  [url=]Yee-Kit Tse[/url]1,2
,  [url=]Lilian Yan Liang[/url]1,2
,  [url=]Vicki Wing-Ki Hui[/url]1,2
,  [url=]Hye Won Lee[/url]1,4
,  [url=]Grace Chung-Yan Lui[/url]2
,  [url=]Henry Lik-Yuen Chan[/url]1,2,3,∗,[url=]Correspondence information about the author  Henry Lik-Yuen Chan[/url]Email the author  Henry Lik-Yuen Chan





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DOI: https://doi.org/10.1016/j.jhep.2019.12.005 |

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Highlights

• •PAGE-B and mPAGE-B scores exclude patients with low HCC risk on antiviral therapy.
• •Patients classified as low HCC risk by either score have an annual risk of <0.2%.
• •Low-risk patients identified by either score can be exempted from HCC surveillance.
• •Caution is needed for patients with cirrhosis or other risk factors for HCC.
  

Background & AimsPAGE-B and modified PAGE-B (mPAGE-B) scores were developed to predict the 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.


MethodsConsecutive 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. The performance of PAGE-B and mPAGE-B scores for 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 2 scores were evaluated by survival analysis.


ResultsOf 32,150 identified patients with chronic hepatitis B, 20,868 (64.9%) were male. Their mean age was 53.0 ± 13.2 years. At a median (IQR) follow-up of 3.9 (1.8–5.0) years, 1,532 (4.8%) patients developed HCC. The AUROCs (95% CI) for the prediction of HCC at 5 years were 0.77 (0.76–0.78) and 0.80 (0.79–0.81), with PAGE-B and mPAGE-B scores, respectively (p <0.001). A total of 9,417 (29.3%) patients were classified as having a low HCC risk by either PAGE-B or mPAGE-B scores; their 5-year cumulative incidence of HCC was 0.6% (0.4%–0.8%). This classification achieved a negative predictive value of 99.5% (99.4%–99.7%) to exclude patients without HCC development at 5 years. The AUROCs for the prediction of HCC with PAGE-B and mPAGE-B scores were similar at baseline and after 2 years on treatment.


ConclusionsPAGE-B and mPAGE-B scores can be applied to identify patients on antiviral therapy who are at low risk of developing HCC. These patients could be exempted from HCC surveillance due to their very low HCC risk.


Lay summaryRisk scores have been developed to predict the likelihood of patients with chronic hepatitis B developing hepatocellular carcinoma (HCC). We investigated the role of 2 such scores, PAGE-B and modified PAGE-B, in predicting the risk of HCC in 32,150 nucleos(t)ide analogue-treated patients with chronic hepatitis B. These scores identified a group of patients at very low risk of developing HCC who could therefore be exempted from HCC surveillance.



Keywords:                Entecavir, Tenofovir, [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Liver cancer&code=jhepat-site]Liver cancer[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Nucleos(t)ide analogues&code=jhepat-site]Nucleos(t)ide analogues[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Risk score&code=jhepat-site]Risk score[/url], HCC, HBV

StephenW

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
叶卓丰叶1,2
，黄丽红1,2,3
，Vincent Wai-Sun Wong1,2,3
，Yee-Kit Tse1,2
，李莲艳良1,2
，惠咏琪1,2
，李慧媛1,4
吕中恩2
，Henry Lik-Yuen Chan1,2,3，∗，'有关作者Henry Lik-Yuen Chan的通讯信息通过电子邮件发送给作者Henry Lik-Yuen Chan
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DOI：https：//doi.org/10.1016/j.jhep.2019.12.005 |
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图形概要

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强调

•PAGE-B和mPAGE-B评分不包括抗病毒治疗的HCC风险低的患者。
•根据任一评分被归类为低肝癌风险的患者的年风险<0.2％。
•通过任一评分确定的低风险患者可以免于HCC监测。
•对于患有肝硬化或其他肝癌危险因素的患者，需要小心。

背景与目标

PAGE-B和修改后的PAGE-B（mPAGE-B）评分可预测使用核苷酸（t）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月期间连续接受恩替卡韦或替诺福韦治疗至少6个月的连续性慢性乙型肝炎成人患者，来自香港全港范围的数据库。根据时间相关的受试者工作特征曲线（AUROC）下的面积评估PAGE-B和mPAGE-B评分在5年时的HCC预测性能，并通过生存率评估这2个评分的不同截止值分析。
结果

在确定的32,150名慢性乙型肝炎患者中，男性为2​​0,868名（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（IQR）随访中，有1,532（4.8％）例患者发生了HCC。预测5年时HCC的AUROC（95％CI）为0.77（0.76-0.78）和0.80（0.79-0.81），分别为PAGE-B和mPAGE-B评分（p <0.001）。通过PAGE-B或mPAGE-B评分将总计9,417（29.3％）的患者归为HCC风险低的患者；他们的5年HCC累积发生率为0.6％（0.4％–0.8％）。该分类排除了5年内未发生HCC的患者，其阴性预测值为99.5％（99.4％–99.7％）。用PAGE-B和mPAGE-B评分预测HCC的AUROC在基线时和治疗2年后相似。
结论

PAGE-B和mPAGE-B评分可用于识别接受抗病毒治疗的肝癌风险低的患者。这些患者的HCC风险极低，因此可以免于HCC监测。
放置摘要

已经开发了风险评分来预测慢性乙型肝炎患者发展为肝细胞癌（HCC）的可能性。我们调查了PAGE-B和改良版PAGE-B这2个评分在预测32,150核苷（t）ide类似物治疗的慢性乙型肝炎患者中HCC的风险中的作用。这些评分确定了一组处于非常低水平的患者患上HCC的风险，因此可以免于HCC监测。
关键字：
恩替卡韦，替诺福韦，肝癌，Nucleos（t）ide类似物，风险评分，HCC，HBV