External validation of CAGE‐B and SAGE‐B scores for Asian chronic hepatitis B patients with well‐controlled viremia by antivirals

Ji, Jung Hyun; Park, Soo Young; Son, Won Jeong; Shin, Hye Jung; Lee, Hyein; Lee, Hye Won; Lee, Jae Seung; Kim, Seung Up; Park, Jun Yong; Ahn, Sang Hoon

doi:10.1111/jvh.13506

Cited by 7 publications

(10 citation statements)

References 58 publications

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“…The strength of this study is that we analyzed a large number of homogeneous patients who were treated uniformly with ETV or TFV for at least for 5 years at two university hospitals. A recent study conducted in South Korea attempted to validate the CAGE-B and SAGE-B scores in Asian patients; however, those treated with other NAs, besides ETV or TFV, or those treated for less than 5 years were included in that study [ 26 ]. In our validation study, which included patients who were essentially the same as the original CAGE-B/SAGE-B cohort, the CAGE-B score yielded an acceptable predictive accuracy with AUCs varying between 0.75 and 0.85 in the entire and subgroup analyses.…”

Section: Discussionmentioning

confidence: 99%

Cirrhosis, Age, and Liver Stiffness-Based Models Predict Hepatocellular Carcinoma in Asian Patients with Chronic Hepatitis B

Lim

Chon

Kim

et al. 2021

Cancers

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Objectives: Predicting hepatocellular carcinoma (HCC) in patients with chronic hepatitis B who received long-term therapy with potent nucleos(t)ide analogs is of utmost importance to refine the strategy for HCC surveillance. Methods: We conducted a multicenter retrospective cohort study to validate the CAGE-B and SAGE-B scores, HCC prediction models developed for Caucasian patients receiving entecavir (ETV) or tenofovir (TFV) for >5 years. Consecutive patients who started ETV or TFV at two hospitals in Korea from January 2009 to December 2015 were identified. The prediction scores were calculated, and model performance was assessed using receiver operating characteristics (ROC) curves. Results: Among 1557 patients included, 57 (3.7%) patients had HCC during a median follow-up of 93 (95% confidence interval, 73–119) months. In the entire cohort, CAGE-B predicted HCC with an area under the ROC curve of 0.78 (95% CI, 0.72–0.84). Models that have “liver cirrhosis” in the calculation, such as AASL (0.79 (0.72–0.85)), CU-HCC (0.77 (0.72–0.82)), and GAG-HCC (0.79 (0.74–0.85)), showed accuracy similar to that of CAGE-B (p > 0.05); however, models without “liver cirrhosis”, including SAGE-B (0.71 (0.65–0.78)), showed a lower predictive ability than CAGE-B. CAGE-B performed well in subgroups of patients treated without treatment modification (0.81 (0.73–0.88)) and of male sex (0.79 (0.71–0.86)). Conclusions: This study validated the clinical usefulness of the CAGE-B score in a large number of Asian patients treated with long-term ETV or TFV. The results could provide the basis for the reappraisal of HCC surveillance strategies and encourage future prospective validation studies with liver stiffness measurements.

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Section: Discussionmentioning

confidence: 99%

Cirrhosis, Age, and Liver Stiffness-Based Models Predict Hepatocellular Carcinoma in Asian Patients with Chronic Hepatitis B

Lim

Chon

Kim

et al. 2021

Cancers

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“…Although THRI (Toronto HCC risk index) has shown good predictive ability for HCC in patients with cirrhosis [ 93 ], it was not superior to mPAGE-B in Korean CHB patients [ 91 ]. Meanwhile, the CAGE-B (cirrhosis and age) and SAGE-B (stiffness and age) models, which were developed from Western studies [ 94 ], has been validated by several Korean retrospective studies [ 95 , 96 ]. A recently developed FSAC (fibrosis marker response, sex, age, cirrhosis) model that incorporates on-therapy changes in non-invasive fibrosis markers (fibrosis-4 [FIB-4] or aspartate aminotransferase-to-platelet ratio index [APRI]) has been validated in a separate cohort of Korean CHB patients [ 97 ].…”

Section: Natural Historymentioning

confidence: 99%

KASL clinical practice guidelines for management of chronic hepatitis B

2022

Clin Mol Hepatol

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“…To solve these problems, novel scoring systems were developed in patients on treatment. The PAGE-B (age, sex and platelet count), CAGE-B (age, presence of baseline cirrhosis), SAGE-B (age, liver stiffness measurements), CAMD (cirrhosis, age, male sex, diabetes mellitus) and HCC-RESCUE (age, sex, cirrhosis) scoring systems all have high negative predictive values for HCC development in their low-risk groups[ 7 , 14 - 16 ]. Among current scoring systems, the PAGE-B is the only one that does not include cirrhosis as a parameter.…”

Section: Discussionmentioning

confidence: 99%

Validation of the PAGE-B score to predict hepatocellular carcinoma risk in caucasian chronic hepatitis B patients on treatment

Gökçen¹,

Güzelbulut²,

Adali³

et al. 2022

WJG

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BACKGROUND Several risk scores have been developed to predict hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) patients. The majority of risk scores are based on pretreatment variables that are no longer considered risk factors for HCC development due to the suppression of hepatitis B virus replication early in the course of potent antiviral treatment in most patients. The PAGE-B score, which is based on platelet levels, age and sex, has been shown to accurately predict HCC risk in CHB patients on antiviral treatment in various populations. AIM We aimed to evaluate the PAGE-B score in predicting HCC risk in Turkish CHB patients on antiviral treatment. METHODS In this study, we recruited 742 CHB patients who had been treated with tenofovir disoproxil fumarate or entecavir for ≥ 1 year. Risk groups were determined according to the PAGE-B scores as follows: ≤ 9, low; 10-17, moderate and ≥ 18, high. The cumulative HCC incidences in each risk group were computed using Kaplan-Meier analysis and were compared using the log-rank test. The accuracy of the PAGE-B score in predicting HCC risk was evaluated using a time-dependent area under the receiver operating characteristic (AUROC) curve at all study time points. Univariate and multivariate logistic regression analyses were used to assess the risk factors for HCC development. RESULTS The mean follow-up time was 54.7 ± 1.2 mo. HCC was diagnosed in 26 patients (3.5%). The cumulative HCC incidences at 1, 3, 5 and 10 years were 0%, 0%, 0% and 0.4% in the PAGE-B low-risk group; 0%, 1.2%, 1.5% and 2.1% in the PAGE-B moderate-risk group; and 5%, 11.7%, 12.5%, and 15% in the PAGE-B high-risk group, respectively (log-rank P < 0.001). The AUROCs of the PAGE-B score in the prediction of HCC development at 1, 3, 5 and 10 years were 0.977, 0.903, 0.903 and 0.865, respectively. In the multivariable analysis, older age, male sex, lower platelet levels, presence of cirrhosis, and absence of alanine aminotransferase normalization at month 6 were associated with HCC development (all P < 0.05). CONCLUSION The PAGE-B score is a practical tool to predict HCC risk in Turkish patients with CHB and may be helpful to improve surveillance strategies.

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External validation of CAGE‐B and SAGE‐B scores for Asian chronic hepatitis B patients with well‐controlled viremia by antivirals

Cited by 7 publications

References 58 publications

Cirrhosis, Age, and Liver Stiffness-Based Models Predict Hepatocellular Carcinoma in Asian Patients with Chronic Hepatitis B

Cirrhosis, Age, and Liver Stiffness-Based Models Predict Hepatocellular Carcinoma in Asian Patients with Chronic Hepatitis B

KASL clinical practice guidelines for management of chronic hepatitis B

Validation of the PAGE-B score to predict hepatocellular carcinoma risk in caucasian chronic hepatitis B patients on treatment

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