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

Papatheodoridis, George V.; Dalekos, George Ν.; Sypsa, Vana; Yurdaydın, Cihan; Buti, Marı́a; Goulis, John; Calleja, José Luís; Chi, Heng; Manolakopoulos, Spilios; Mangia, G.; Gatselis, Nikolaos; Keskın, Onur; Savvidou, Savvoula; Revilla, Juan de la; Hansen, Bettina E.; Vlachogiannakos, Jiannis; Galanis, Kostantinos; İdilman, Ramazan; Colombo, M.; Esteban, Rafael; Janssen, Harry L.A.; Lampertico, Pietro

doi:10.1016/j.jhep.2015.11.035

Cited by 420 publications

(552 citation statements)

References 26 publications

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“…Evaluation was performed with and without the inclusion of HCC cases diagnosed within the fi rst year, to exclude prevalent cases. We also used the recently published PAGE-B model, which is calculated based on patients' age, gender, and platelet count, and validated in a Caucasian cohort, for further sensitivity analysis and evaluation of its prognostic capability in our mainly Asian cohort ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Lower Observed Hepatocellular Carcinoma Incidence in Chronic Hepatitis B Patients Treated With Entecavir: Results of the ENUMERATE Study

Ahn

Lim

Lee

et al. 2016

American Journal of Gastroenterology

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OBJECTIVES:Data from the United States are lacking regarding the impact of entecavir (ETV) on the risk of hepatocellular carcinoma (HCC). Our aim is to determine whether treatment with ETV is associated with a reduced HCC risk by calculating the expected HCC incidence based on the Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B) model and comparing it with the observed HCC incidence. METHODS:The incidence of HCC in US patients treated with ETV between 2005 and 2013 in a retrospective cohort was obtained. The predicted HCC incidence was calculated using the REACH-B model. The standardized incidence ratios (SIRs) were calculated as a ratio of observed over predicted HCC cases. RESULTS:Of 841 patients, 646 (65% male, 84% Asian, median age 47 years, 36% hepatitis B e antigen positive, 9.4% with cirrhosis) met the inclusion criteria. Over a median follow-up of 4 years, 17 (2.6%) cases of HCC were diagnosed, including 8 out of 61 (13.1%) patients with cirrhosis and 9 out of 585 (1.5%) without cirrhosis. Compared with those without HCC, the 17 patients with HCC were older at 53 years vs. 47 years and more likely to have cirrhosis at 47.1% vs. 8.4%. Among patients without cirrhosis, the observed HCC incidence was signifi cantly lower than predicted by the fourth year (SIR, 0.37; 95% confi dence interval: 0.166-0.82). A sensitivity analysis that comprised all patients, including those with cirrhosis, showed that at the maximum follow-up time of 8.2 years, a signifi cantly lower than predicted HCC incidence was noted with an SIR of 0.56 (95% confi dence interval: 0.35-0.905).CONCLUSIONS: Based on the REACH-B model, long-term ETV therapy was associated with a lower than predicted HCC incidence. However, the risk of HCC persisted, and careful HCC surveillance remains warranted despite the anti-viral treatment.SUPPLEMENTARY MATERIAL is linked to the online version of the paper at

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Section: Discussionmentioning

confidence: 99%

Lower Observed Hepatocellular Carcinoma Incidence in Chronic Hepatitis B Patients Treated With Entecavir: Results of the ENUMERATE Study

Ahn

Lim

Lee

et al. 2016

American Journal of Gastroenterology

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“…The Asian HCC risk scores, GAG-HCC, CU-HCC and REACH-B, have been validated in treated Asian CHB patients, 25 however the PAGE-B score is the only one that offers good predictability for HCC in Caucasian treated CHB patients. 28 Based on the HCC risk scores, patients can be classified into those at low, medium and high risk of HCC. Patients in the low HCC risk group have no or negligible probability of HCC development and therefore may not require HCC surveillance.…”

Section: Long-term Outcome During Na Recommendationsmentioning

confidence: 99%

“…Patients in the low HCC risk group have no or negligible probability of HCC development and therefore may not require HCC surveillance. 25,28 Despite the remaining risk of developing HCC, the overall survival improves in patients under long-term effective NA(s) therapy. 1,39,[94][95][96] Loss of HBsAg during long-term NA therapy may occur in a minority of CHB patients who were initially HBeAg-positive (approximately 10-12% after 5-8 years of therapy) while is rare in patients with HBeAg-negative CHB (\1-2% after 5-8 years of therapy).…”

Section: Long-term Outcome During Na Recommendationsmentioning

confidence: 99%

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

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

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3,081

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“…Different scores in different settings have been suggested, i.e. GAG-HCC [61], CU-HCC [62], REACH-B [63], and PAGE-B score [64]. The risk assessment is based on patient (age, gender, cirrhosis, platelets) as well as viral factors (HBV DNA).…”

Section: Effect Of Antiviral Therapy On Hcc Developmentmentioning

confidence: 99%

Management of HBV and HBV/HDV-Associated Liver Cirrhosis

Siederdissen

Cornberg

2016

Visc Med

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Background: Chronic hepatitis B virus (HBV) infection and hepatitis delta virus (HDV) co-infection lead to liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Methods: We review the current knowledge of the management of HBV mono-infection and HBV/HDV co-infection with a special emphasis on liver cirrhosis. Results: Treatment options for chronic hepatitis B are pegylated interferon (PEG-IFN) alfa and nucleos(t)ide analogues (NUC). PEG-IFN is a finite option to achieve hepatitis B surface antigen loss in compensated cirrhosis. However, this goal is rare. NUC are potent to achieve HBV DNA suppression but long-term treatment is mandatory in most cases. Long-term treatment with NUC can lead to reversion of liver cirrhosis, improve liver function, prevent liver transplantation, and reduces but does not eliminate the risk for development of HCC. Treatment options for hepatitis D are limited to PEG-IFN. Although late relapse is common, treatment with PEG-IFN reduces disease progression. However, new treatments are urgently needed for HDV infection. Conclusion: Early treatment of chronic hepatitis B and D is important to prevent complications of cirrhosis. HCC surveillance remains important in patients with cirrhosis.

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

Cited by 420 publications

References 26 publications

Lower Observed Hepatocellular Carcinoma Incidence in Chronic Hepatitis B Patients Treated With Entecavir: Results of the ENUMERATE Study

Lower Observed Hepatocellular Carcinoma Incidence in Chronic Hepatitis B Patients Treated With Entecavir: Results of the ENUMERATE Study

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

Management of HBV and HBV/HDV-Associated Liver Cirrhosis

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