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

Abstract

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.

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

“…The diagnostic accuracy of the PAGE-B score in HCC prediction was explored in subsequent studies. A retrospective study conducted by Gokcen et al aimed to assess the accuracy of the PAGE-B score in predicting the risk of HCC among 742 Turkish CHB patients undergoing TDF or ETV therapy for a minimum of 1 year [ 20 ]. The mean follow-up for these patients was recorded as 54.7 ± 1.2 months.…”

“…The cumulative HCC incidence at 1, 3, 5, and 10 years was observed as follows: 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. The AUROC values of the PAGE-B score in predicting HCC development at 1, 3, 5, and 10 years were recorded as 0.977, 0.903, 0.903, and 0.865, respectively [ 20 ].…”

Long-Term Survival and Curative-Intent Treatment in Hepatitis B or C Virus-Associated Hepatocellular Carcinoma Patients Diagnosed during Screening

“…The most common contributing risk factor for HCC is the development of cirrhosis from chronic infection with the hepatitis B virus (HBV) and/or the hepatitis C virus (HCV) [ 3 , 4 , 5 ]. The progression from initial HBV and/or HCV infection to chronic hepatitis and to cirrhosis ultimately leads to hepatocarcinogenesis and the development of HCC [ 2 , 6 , 7 , 8 ]. Limiting the progression to cirrhosis in patients with hepatitis virus infections requires the early identification and initiation of effective anti-viral treatment.…”

Avaliação dos escores preditores de carcinoma hepatocelular em portadores de infecção crônica pelo vírus da hepatite B em um serviço de saúde terciário no Brasil

“…et al(2022)[62] encontraram incidência cumulativa de CHC em 3 e 5 anos através do PAGE-B, de 0% e 0% para baixo, 1,2% e 1,5% para moderado e 11,7% e 12,5% para alto risco respectivamente (log-rank p< 0,001), aproximando-se deste estudo apenas a previsão do alto risco em 5 anos.Porém, na população estudada por eles, incluíram-se apenas os que estavam em tratamento medicamentoso e os que possuíam cirrose descompensada. Na atual análise, quatro pacientes não possuíam cirrose ao diagnóstico de ICVHB e evoluíram para CHC com escores de intermediário e alto risco (exceto um caso classificado como baixo pelo mPAGE-B já discutido anteriormente), similar aos 11 pacientes com cirrose ao início, demonstrando que os escores podem ter boa predição em pacientes independente do grau de fibrose hepática, necessitando de estudos com maior número de pacientes para validação dessa hipótese.O estudo apresenta algumas limitações.…”