PAGE-B and REACH-B Predicts the Risk of Developing Hepatocellular Carcinoma in Chronic Hepatitis B Patients from Northeast, Brazil

Abstract

This study aims to evaluate the accuracy of the PAGE-B and REACH-B scores in predicting the risk of developing HCC in patients with chronic hepatitis B regularly followed up at a reference service in the State of Maranhão. A historical, longitudinal, retrospective cohort study, carried out from the review of medical records of patients with chronic Hepatitis B. PAGE-B and REACH-B scores were calculated and the accuracy of the scores in predicting the risk of HCC in the studied population was evaluated. A total of 978 patients were included, with a median age of around 47 years, most of them female and not cirrhotic. HCC was identified in 34 patients. Thrombocytopenia, high viral load, male gender and age were associated with the occurrence of HCC. The ROC curve for the PAGE-B score showed a value of 0.78 and for the REACH-B score of 0.79. The cutoff point for PAGE-B was 11 points for greater sensitivity and for REACH-B 7.5 points considering greater sensitivity and 9.5 points considering greater specificity. PAGE-B and REACH-B scores were able to predict the risk of developing HCC in the studied population. The use of risk stratification scores is useful to reduce costs associated with HCC screening.

Liver Carcinogenesis Suppression in Chronic Hepatitis B in the Nucleoside Analogues Era

“…In addition to age, sex, and platelet counts in PAGE-B, albumin level was included as a risk factor in this study, which was also validated (35). In addition, Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B), Individual Prediction Model (IPM), CU-HCC, Guide with Age, Gender, HBV DNA, Core Promoter Mutations and Cirrhosis-HCC (GAG-HCC), and Nomogram-HCC (NGM-HCC) are also used (36)(37)(38). Recently, artificial intelligence has also been vigorously used to predict liver carcinogenesis during NA treatment (39).…”

Evaluation of PAGE-B Score for Hepatocellular Carcinoma Development in Chronic Hepatitis B Patients: Reliability, Validity, and Responsiveness

“…The ROC curve for the PAGE-B score yielded a value of 0.78 (0.79 for REACH-B). The PAGE-B cutoff determined to maximize sensitivity was 11 points [ 21 ]. Further examination of the ROC curve highlighted an improved AUC with increasing years of follow-up.…”

“…Further examination of the ROC curve highlighted an improved AUC with increasing years of follow-up. The authors concluded that patients scoring below 11 points on the PAGE-B scale may warrant longer screening periods compared to conventional practice [ 21 ].…”

HIV-HBV Coinfection—Current Challenges for Virologic Monitoring

“…PAGE-B index (comprising platelets, age, and gender) can predict the 5-year HCC risk in Caucasian HBV-infected patients with or without NA treatment [116,120]. EASL guidelines suggests that patients with a low PAGE-B score might even not require HCC surveillance [117].…”