George Papatheodoridis1, George Dalekos2, Vana Sypsa3, Cihan Yurdaydin4, Maria Buti5, John Goulis6, Jose Luis Calleja7, Heng Chi8, Spilios Manolakopoulos9, Giampaolo Mangia10, Nikolaos Gatselis2, Onur Keskin4, Savvoula Savvidou6, Juan de la Revilla7, Bettina E Hansen8, Ioannis Vlachogiannakos11, Kostantinos Galanis2, Ramazan Idilman4, Massimo Colombo10, Rafael Esteban5, Harry L A Janssen12, Pietro Lampertico10. 1. Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: gepapath@med.uoa.gr. 2. Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece. 3. Department of Hygiene, Epidemiology & Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 4. Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey. 5. Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain. 6. 4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece. 7. Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain. 8. Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, Netherlands. 9. 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 10. Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy. 11. Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece. 12. Department of Gastroenterology & Hepatology, ErasmusMC, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada.
Abstract
BACKGROUND & AIMS: Risk scores for hepatocellular carcinoma (HCC) developed in Asians offer poor-moderate predictability in Caucasian patients with chronic hepatitis B (CHB). This nine center cohort study aimed to develop and validate an accurate HCC risk score in Caucasian CHB patients treated with the current oral antivirals, entecavir/tenofovir. METHODS: We included 1815 adult Caucasians with CHB and no HCC at baseline who received entecavir/tenofovir for ⩾12 months. Using data from eight centers (derivation dataset, n=1325), a HCC risk score was developed based on multivariable Cox models and points system for simplification. Harrell's c-index was used as discrimination, bootstrap for internal validation and the data from the 9(th) and largest center (validation dataset, n=490) for external validation. RESULTS: The 5-year cumulative HCC incidence rates were 5.7% and 8.4% in the derivation and validation dataset, respectively. In the derivation dataset, age, gender, platelets and cirrhosis were independently associated with HCC. The PAGE-B score was developed based on age, gender and platelets (c-index=0.82, 0.81 after bootstrap validation). The addition of cirrhosis did not substantially improve the discrimination (c-index=0.84). The predictability of PAGE-B score was similar (c-index=0.82) in the validation dataset. Patients with PAGE-B ⩽9, 10-17, ⩾18 had 5-year cumulative HCC incidence rates of 0%, 3%, 17% in the derivation and 0%, 4%, 16% in the validation dataset. CONCLUSION: PAGE-B, which is based only on baseline patients' age, gender and platelets, represents a simple and reliable score for prediction of the 5-year HCC risk in Caucasian CHB patients under entecavir/tenofovir.
BACKGROUND & AIMS: Risk scores for hepatocellular carcinoma (HCC) developed in Asians offer poor-moderate predictability in Caucasian patients with chronic hepatitis B (CHB). This nine center cohort study aimed to develop and validate an accurate HCC risk score in Caucasian CHB patients treated with the current oral antivirals, entecavir/tenofovir. METHODS: We included 1815 adult Caucasians with CHB and no HCC at baseline who received entecavir/tenofovir for ⩾12 months. Using data from eight centers (derivation dataset, n=1325), a HCC risk score was developed based on multivariable Cox models and points system for simplification. Harrell's c-index was used as discrimination, bootstrap for internal validation and the data from the 9(th) and largest center (validation dataset, n=490) for external validation. RESULTS: The 5-year cumulative HCC incidence rates were 5.7% and 8.4% in the derivation and validation dataset, respectively. In the derivation dataset, age, gender, platelets and cirrhosis were independently associated with HCC. The PAGE-B score was developed based on age, gender and platelets (c-index=0.82, 0.81 after bootstrap validation). The addition of cirrhosis did not substantially improve the discrimination (c-index=0.84). The predictability of PAGE-B score was similar (c-index=0.82) in the validation dataset. Patients with PAGE-B ⩽9, 10-17, ⩾18 had 5-year cumulative HCC incidence rates of 0%, 3%, 17% in the derivation and 0%, 4%, 16% in the validation dataset. CONCLUSION: PAGE-B, which is based only on baseline patients' age, gender and platelets, represents a simple and reliable score for prediction of the 5-year HCC risk in Caucasian CHB patients under entecavir/tenofovir.
Authors: Mar Riveiro-Barciela; David Tabernero; José L Calleja; Sabela Lens; María L Manzano; Francisco Gea Rodríguez; Javier Crespo; Belén Piqueras; Juan M Pascasio; Carmen Comas; Maria L Gutierrez; Alberto Aguirre; Emilio Suárez; Javier García-Samaniego; Miguel Rivero; Doroteo Acero; Miguel Fernandez-Bermejo; Diego Moreno; Pilar Sánchez-Pobre; Beatriz de Cuenca; J J Moreno-Palomares; Rafael Esteban; Maria Buti Journal: Dig Dis Sci Date: 2017-01-11 Impact factor: 3.199
Authors: Joseph Ahn; Joseph K Lim; Hannah M Lee; Anna S Lok; Mindie Nguyen; Calvin Q Pan; Ajitha Mannalithara; Helen Te; K Rajender Reddy; Huy Trinh; Danny Chu; Tram Tran; Daryl Lau; Truong-Sinh Leduc; Albert Min; Loc Trong Le; Ho Bae; Sang Van Tran; Son Do; Hie-Won L Hann; Clifford Wong; Steven Han; Anjana Pillai; James S Park; Myron Tong; Steve Scaglione; Jocelyn Woog; W Ray Kim Journal: Am J Gastroenterol Date: 2016-06-21 Impact factor: 10.864
Authors: Josep M Llovet; Robin Kate Kelley; Augusto Villanueva; Amit G Singal; Eli Pikarsky; Sasan Roayaie; Riccardo Lencioni; Kazuhiko Koike; Jessica Zucman-Rossi; Richard S Finn Journal: Nat Rev Dis Primers Date: 2021-01-21 Impact factor: 52.329