Predictive score for hepatocellular carcinoma after hepatitis B e antigen loss in patients treated with entecavir or tenofovir

Lim, Tae-Young; Lee, Hyun Woong; Lee, Jung Il; Kim, In Hee; Lee, Chang-Hun; Jang, Byoung Kuk; Chung, Woo Jin; Yim, Hyung Joon; Suh, Sang Jun; Seo, Yeon Seok; Lee, Yong Sang; Yu, Jung Hwan; Lee, Jin Woo; Kim, Sang Gyune; Kim, Young Seok; Park, Soo Young; Tak, Won Young; Kim, Soon Sun; Cheong, Jae Youn; Jeong, Soung Won; Jang, Jae Young; Rou, Woo Sun; Lee, Byung Seok; Kim, Seung Up

doi:10.1111/jvh.13316

Cited by 7 publications

(7 citation statements)

References 40 publications

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“…The HCC-ESC score may be more suitable for patients without antiviral treatment. In 2020, a new risk prediction model for HCC development after ESC in CHB patients with antiviral therapy was established[ 56 ]. The HCC-ESC AVT (antiviral therapy) model was derived from a cohort of 769 and validated from a cohort of 1061 patients with CHB who experienced ESC during entecavir or tenofovir treatment.…”

Section: Hcc Prediction Scores In Treated Patients During Nas Treatmentmentioning

confidence: 99%

Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Guo

Gao

2021

WJCC

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Chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) is a major health problem in Asian-Pacific regions. Antiviral therapy reduces, but does not completely prevent, HCC development. Thus, there is a need for accurate risk prediction to assist prognostication and decisions on the need for antiviral therapy and HCC surveillance. A few risk scores have been developed to predict the occurrence of HCC in CHB patients. Initially, the scores were derived from untreated CHB patients. With the development and extensive clinical application of nucleos(t)ide analog(s) (NA), the number of risk scores based on treated CHB patients has increased gradually. The components included in risk scores may be categorized into host factors and hepatitis B virus factors. Hepatitis activities, hepatitis B virus factors, and even liver fibrosis or cirrhosis are relatively controlled by antiviral therapy. Therefore, variables that are more dynamic during antiviral therapy have since been included in risk scores. However, host factors are more difficult to modify. Most existing scores derived from Asian populations have been confirmed to be accurate in predicting HCC development in CHB patients from Asia, while these scores have not offered excellent predictability in Caucasian patients. These findings support that more relevant variables should be considered to provide individualized predictions that are easily applied to CHB patients of different ethnicities. CHB patients should receive different intensities of HCC surveillance according to their risk category.

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Section: Hcc Prediction Scores In Treated Patients During Nas Treatmentmentioning

confidence: 99%

Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Guo

Gao

2021

WJCC

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“…Furthermore, US remains a widely feasible modality for detecting liver cirrhosis. 10,33 For these reasons, we used both US and TE to differentiate patients with CHB-related cirrhosis. To identify a specific patient subset with distinctly better prognosis, the study patients were divided into four groups: US(+)…”

Section: Group Stratificationmentioning

confidence: 99%

“…[3][4][5][6] Although HBV DNA level is one of the most important predictors of HCC development, 7 its clinical implication has substantially diminished as potent antiviral therapies have been used to treat CHB. However, since LRE can develop during the course of antiviral therapy, [8][9][10] assessment of any remaining fibrotic burden to identify advanced fibrosis or cirrhosis during antiviral therapy is still important to predict the risk of LRE. 11 To date, liver biopsy remains the gold standard for evaluating liver fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Risk assessment of hepatocellular carcinoma and liver‐related events using ultrasonography and transient elastography in patients with chronic hepatitis B

Yoo

Lim

Lee

et al. 2021

Journal of Viral Hepatitis

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Cirrhosis has prognostic value. We investigated whether the combined use of ultrasonography (US) and transient elastography (TE) to diagnose cirrhosis is beneficial for the risk assessment of hepatocellular carcinoma (HCC) and liver-related events in patients with chronic hepatitis B (CHB). A total of 9300 patients with CHB who underwent US and TE in two institutions between 2006 and 2018 were enrolled. TE value ≥13 kPa was set to indicate cirrhosis. Patients were divided into four groups: US(+) TE(+) (cirrhosis by US and TE), US(+)TE(−) (cirrhosis by US, but not by TE), US(−)TE(+) (cirrhosis by TE, but not by US) and US(−)TE(−) (non-cirrhosis by US and TE).The patients were predominantly male (n = 5474, 58.9%) with a mean age of 47.5 years. The proportions of patients with cirrhosis diagnosed by US and TE were 17.2% (n = 1595) and 13.2% (n = 1225), respectively. The proportion of patients with discordant results in diagnosing cirrhosis by US and TE was 18.7% (n = 1740). During follow-up (median: 60.0 months), HCC and liver-related events developed in 481 (5.2%) and 759 (8.2%) patients, respectively. The cumulative incidence rates of HCC and liverrelated events were highest in the US(+)TE(+) group, intermediate-high in the US(−) TE(+) group, intermediate-low in the US(+)TE(−) group and lowest in the US(−)TE(−) group (overall p < .001). Cirrhosis assessed using US and TE was a major predictor of HCC and liver-related event development in patients with CHB. Cirrhosis assessed using TE seemed better in predicting HCC or liver-related events than using US, when cirrhosis diagnosis was discordant by US and TE.| 1363 YOO et al.

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“…All AUROCs for HCC prediction were higher than 0.8 at 3, 5, and 10 years, with a better predictive performance than PAGE-B in the same cohort (AUROC values at same time points; 0.73-0.74). The previously described HCC-ESC score was revised in 2020 in a Korean cohort of CHB patients under antiviral treatment and called HCC-ESC AVT [ 49 ]. The risk score targeted CHB patients with HBeAg seroclearance like the original version and used the following three parameters: Male gender, cirrhosis, and fibrosis-4 index.…”

Section: Hcc Risk Scores For Chb Patientsmentioning

confidence: 99%

Surveillance for hepatocellular carcinoma in chronic viral hepatitis: Is it time to personalize it?

Demirtaş¹,

Brunetto²

2021

WJG

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Surveillance with abdominal ultrasound with or without alpha-fetoprotein is recommended by clinical practice guidelines for patients who are considered to be at risk of developing hepatocellular carcinoma (HCC), including those with cirrhosis, advanced fibrosis and special subgroups of chronic hepatitis B (CHB). Application of the standard surveillance strategy to all patients with chronic liver disease (CLD) with or without cirrhosis imposes major sustainability and economic burdens on healthcare systems. Thus, a number of HCC risk scores were constructed, mainly from Asian cohorts, to stratify the HCC prediction in patients with CHB. Similarly, even if less than for CHB, a few scoring systems were developed for chronic hepatitis C patients or cirrhotic patients with CLD of different etiologies. Recently, a few newsworthy HCC-risk algorithms were developed for patients with cirrhosis using the combination of serologic HCC markers and clinical parameters. Overall, the HCC risk stratification appears at hand by several validated multiple score systems, but their optimal performance is obtained only in populations who show highly homogenous clinic-pathologic, epidemiologic, etiologic and therapeutic characteristics and this limitation poses a major drawback to their sustainable use in clinical practice. A better understanding of the dynamic process driving the progression from CLD to HCC derived from studies based on molecular approaches and genetics, epigenetics and liquid biopsy will enable the identification of new biomarkers to define the individual risk of HCC in the near future, with the possibility to achieve a real and cost/effective personalization of surveillance.

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Predictive score for hepatocellular carcinoma after hepatitis B e antigen loss in patients treated with entecavir or tenofovir

Cited by 7 publications

References 40 publications

Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Risk assessment of hepatocellular carcinoma and liver‐related events using ultrasonography and transient elastography in patients with chronic hepatitis B

Surveillance for hepatocellular carcinoma in chronic viral hepatitis: Is it time to personalize it?

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