Entecavir treatment does not eliminate the risk of hepatocellular carcinoma in chronic hepatitis B: limited role for risk scores in Caucasians

Abstract

Cumulative incidence of HCC is low in patients treated with ETV, but ETV does not eliminate the risk of HCC. Discriminatory performance of HCC risk scores was limited, particularly in Caucasians, at baseline and during therapy.

Hepatitis B Virus Combo Mutations Improve the Prediction and Active Prophylaxis of Hepatocellular Carcinoma: A Clinic-Based Cohort Study

“…Some of these risk factors have been used to construct clinical scoring systems for the prediction of HCC (12)(13)(14)(15). However, HBeAg sero-status and the levels of HBV DNA and ALT are usually changeable during the long-term HBV infection, and differ among the patients infected with different HBV genotypes, which might result in low discriminatory performance in different populations (16)(17)(18)(19)(20)(21). Therefore, more robust biomarkers are needed to improve the prediction power of the current clinical scoring systems.…”

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…Most of them, such as GAG-HCC, CU-HCC and REACH-B, have been developed and validated in Asian untreated CHB patients, 25 but they do not seem to offer good predictability in most studies including Caucasian CHB patients. 26,27 A recently developed and validated new score, PAGE-B, offers good predictability for HCC during the first 5 years of entecavir or tenofovir therapy in Caucasian, mostly European, CHB patients and can be easily applied in clinical practice, as it is based on widely available parameters (platelets, age, gender).…”

Oral antiviral therapy reduces the risk of hepatocellular carcinoma in persons with chronic hepatitis B infection: combining evidence and common sense

“…within the VIRGIL Network, the 5-year cumulative incidence rates of HCC were 2.1 and 10.9 % for non-cirrhotic and cirrhotic patients, respectively [18]. They concluded that the cumulative incidence of HCC is low in patients treated with ETV, but that ETV does not eliminate the risk of HCC.…”

“…However, this would need much bigger sample sizes in order to have a large enough number of patients left after PSM. Another approach is to compare the observed incidence of HCC in the treated cohort with that projected in untreated cohorts by prediction models such as CU-HCC, GAG-HCC or REACH-B [18]. This should also be carried out cautiously because the application of the models is conditional, for example, other hosts (such as ethnic groups) and viral factors (such as genotype and HBeAg status) which should be taken into consideration.…”

“…This should also be carried out cautiously because the application of the models is conditional, for example, other hosts (such as ethnic groups) and viral factors (such as genotype and HBeAg status) which should be taken into consideration. For example, a European study did show that HCC prediction models derived from Asian populations had a poorer performance in Caucasian patients [18]. Medical insurance database analysis would offer the chance of populationbased study but the correct linkage of personal data and the appropriate management of missing data would also pose technical challenges.…”