BACKGROUND & AIMS Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. METHODS We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. RESULTS Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P < .05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8-13), and 24.3% in patients with high CAMD scores (>13) (P < .001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. CONCLUSIONS We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

中文翻译：

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在接受抗病毒治疗的慢性乙型肝炎病毒感染患者中验证 CAMD 评分。

背景和目的 研究人员之前开发了一个评分系统，用于根据肝硬化、患者年龄、男性和糖尿病（称为 CAMD评分系统）。我们验证了 CAMD 评分系统，并将其性能与独立队列中的其他风险评估模型的性能进行了比较。方法 我们随访了 3277 名接受恩替卡韦 (n = 1725) 或替诺福韦 (n = 1552) 作为一线抗病毒药物治疗的慢性 HBV 感染患者（平均年龄 48.7 岁；62.6% 男性；32.4% 患有肝硬化）在大韩民国的 4 家学术教学医院。主要结果是 HCC 的发展。我们评估了 CAMD、PAGE-B、和 mPAGE-B 评分系统，使用曲线下积分面积 (iAUC) 分析来识别将发展为 HCC 的患者。结果 在 58.2 个月的中位随访期内，8.9% 的患者发展为 HCC。与未发展为 HCC 的患者相比，发展为 HCC 的患者年龄较大，更可能是男性，并且肝硬化和糖尿病的比例更高（所有 P < .05）。CAMD 评分确定了 iAUC 为 0.790 的 HCC 患者，mPAGE-B 评分的 iAUC 为 0.769，PAGE-B 评分的 iAUC 为 0.760。CAMD 评分低 (<8) 患者的 HCC 5 年累积风险为 1.3%，CAMD 评分中等 (8-13) 患者为 8.0%，CAMD 评分高 (>13) 患者为 24.3%（ P < .001 用于比较低分组与中分组以及中分组与高分组之间）。HCC 的预测和观察概率非常一致。结论 我们验证了 CAMD 评分系统在确定接受恩替卡韦或替诺福韦治疗的慢性 HBV 治疗患者发生 HCC 的风险方面。验证是在大韩民国的一组患者中进行的，其中大多数患者具有基因型 C2 HBV 感染。