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Reassessing the accuracy of PAGE-B-related scores to predict hepatocellular carcinoma development in patients with chronic hepatitis B
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.jhep.2019.12.005 Terry Cheuk-Fung Yip 1 , Grace Lai-Hung Wong 2 , Vincent Wai-Sun Wong 2 , Yee-Kit Tse 1 , Lilian Yan Liang 1 , Vicki Wing-Ki Hui 1 , Hye Won Lee 3 , Grace Chung-Yan Lui 4 , Henry Lik-Yuen Chan 2
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.jhep.2019.12.005 Terry Cheuk-Fung Yip 1 , Grace Lai-Hung Wong 2 , Vincent Wai-Sun Wong 2 , Yee-Kit Tse 1 , Lilian Yan Liang 1 , Vicki Wing-Ki Hui 1 , Hye Won Lee 3 , Grace Chung-Yan Lui 4 , Henry Lik-Yuen Chan 2
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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.
更新日期：2020-05-01
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