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J Hepatol. 2016 Apr;64(4):800-6. doi: 10.1016/j.jhep.2015.11.035. Epub 2015 Dec 8.

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

Author information

1
Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: gepapath@med.uoa.gr.
2
Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece.
3
Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
4
Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
5
Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain.
6
4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
7
Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain.
8
Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, Netherlands.
9
2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
10
Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.
11
Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
12
Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada.

Abstract

BACKGROUND & AIMS:

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.

KEYWORDS:

Entecavir; Hepatitis B; Hepatocellular carcinoma; Tenofovir

PMID:
26678008
DOI:
10.1016/j.jhep.2015.11.035
[Indexed for MEDLINE]

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