Published online Feb 14, 2022. doi: 10.3748/wjg.v28.i6.665
Peer-review started: June 20, 2021
First decision: July 14, 2021
Revised: July 27, 2021
Accepted: January 19, 2021
Article in press: January 19, 2022
Published online: February 14, 2022
Processing time: 233 Days and 12.2 Hours
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.
We aimed to evaluate the PAGE-B score in predicting HCC risk in Turkish CHB patients on antiviral treatment.
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.
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).
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.
Core Tip: We evaluated the accuracy of the PAGE-B score in predicting hepatocellular carcinoma (HCC) risk in Turkish patients with chronic hepatitis B on antiviral treatment. The cumulative HCC incidences at 5 and 10 years were 0% and 0.4%, 1.5% and 2.1%, and 12.5% and 15.0% in the low-, moderate- and high-risk groups based on the PAGE-B score, respectively. The area under the receiver operating characteristics of the PAGE-B score in the prediction of HCC risk at 5 and 10 years were 0.903 and 0.865, respectively. The PAGE-B score was found to be highly negative predictive and reliable for a cutoff value of ≤ 9 in predicting HCC development.