PAGE-B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5-year antiviral therapy

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• 作者：George Papatheodoridis¹ ; ² ; ^{gepapath@med.uoa.gr" class="auth_mail" title="E-mail the corresponding author} ; George Dalekos³ ; Vana Sypsa⁴ ; Cihan Yurdaydin⁵ ; Maria Buti⁶ ; John Goulis⁷ ; Jose Luis Calleja⁸ ; Heng Chi⁹ ; Spilios Manolakopoulos² ; Giampaolo Mangia¹⁰ ; Nikolaos Gatselis³ ; Onur Keskin⁵ ; Savvoula Savvidou⁷ ; Juan de la Revilla⁸ ; Bettina E. Hansen⁹ ; Ioannis Vlachogiannakos¹ ; Kostantinos Galanis³ ; Ramazan Idilman⁵ ; Massimo Colombo¹⁰ ; Rafael Esteban⁶ ; Harry L.A. Janssen⁹ ; ¹¹ ; Pietro Lampertico¹⁰
• 关键词：NA(s) ; nucleos(t)ide analogue(s) ; ETV ; entecavir ; TDF ; tenofovir disoproxil fumarate ; HBV ; hepatitis B virus ; CHB ; chronic hepatitis B ; HCC ; hepatocellular carcinoma ; ALT ; alanine aminotransferase ; IQR ; interquartile range ; HR ; hazard ratio ; CI ; confidence interval(s)
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：64
• 期：4
• 页码：800-806
• 全文大小：694 K

文摘

Risk scores for hepatocellular carcinoma (HCC) developed in Asians offer poor-moderate predictability in Caucasian patients with chronic hepatitis B (CHB). This nine center cohort study aimed to develop and validate an accurate HCC risk score in Caucasian CHB patients treated with the current oral antivirals, entecavir/tenofovir.

Methods

We included 1815 adult Caucasians with CHB and no HCC at baseline who received entecavir/tenofovir for ⩾12 months. Using data from eight centers (derivation dataset, n = 1325), a HCC risk score was developed based on multivariable Cox models and points system for simplification. Harrell’s c-index was used as discrimination, bootstrap for internal validation and the data from the 9^th and largest center (validation dataset, n = 490) for external validation.

Results

The 5-year cumulative HCC incidence rates were 5.7% and 8.4% in the derivation and validation dataset, respectively. In the derivation dataset, age, gender, platelets and cirrhosis were independently associated with HCC. The PAGE-B score was developed based on age, gender and platelets (c-index = 0.82, 0.81 after bootstrap validation). The addition of cirrhosis did not substantially improve the discrimination (c-index = 0.84). The predictability of PAGE-B score was similar (c-index = 0.82) in the validation dataset. Patients with PAGE-B ⩽9, 10–17, ⩾18 had 5-year cumulative HCC incidence rates of 0%, 3%, 17% in the derivation and 0%, 4%, 16% in the validation dataset.

Conclusion

PAGE-B, which is based only on baseline patients’ age, gender and platelets, represents a simple and reliable score for prediction of the 5-year HCC risk in Caucasian CHB patients under entecavir/tenofovir.