Predictive performance of newer Asian hepatocellular carcinoma risk scores in treated Caucasians with chronic hepatitis B.

BACKGROUND & AIMS

Recently, several risk scores for prediction of hepatocellular carcinoma (HCC) were developed in cohorts of treated Asian patients with chronic hepatitis B (CHB), but they have not been assessed in non-Asian patients. We evaluated the predictability and comparative utility of our PAGE-B and recent Asian HCC risk scores in nucleos(t)ide analogue (NA)-treated adult Caucasian patients with CHB, with or without well-documented compensated cirrhosis but not previous diagnosis of HCC.

METHODS

We included 1,951 patients treated with entecavir/tenofovir and followed up for a median of 7.6 years. The c-statistic was used to estimate the predictability of PAGE-B, HCC-Rescue, CAMD, mPAGE-B, and AASL score for HCC development within 5 or 10 years. The low- and high-risk group cut-offs were used for estimation of negative (NPV) and positive predictive values (PPV), respectively.

RESULTS

HCC developed in 103/1,951 (5.3%) patients during the first 5 years and in another 39/1,428 (2.7%) patients between years 5 and 10. The 3-, 5-, and 10-year cumulative HCC rates were 3.3%, 5.9%, and 9.6%, respectively. All scores offered good 5- and 10-year HCC prediction (c-statistic: 0.78-0.82). NPVs were always >99% (99.3-100%), whereas PPV ranged between 13% and 24%.

CONCLUSIONS

In NA-treated Caucasian patients with CHB including compensated cirrhosis, HCC risk scores developed in NA-treated Asian patients offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis, but the addition of albumin in mPAGE-B score does not seem to offer an advantage in patients with well compensated liver disease.

LAY SUMMARY

Several risk scores for prediction of hepatocellular carcinoma (HCC) were recently developed in cohorts of treated Asian patients with chronic hepatitis B (CHB). In Caucasian patients with CHB treated with oral antivirals, newer Asian HCC risk scores offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. For clinical practice, PAGE-B and mPAGE-B scores are simpler, as they do not require an accurate diagnosis of cirrhosis.

Informations de copyright

© 2021 The Authors.

Déclaration de conflit d'intérêts

GVP has served as advisor/lecturer for Abbvie, Dicerna, Gilead, GlaxoSmithKline, Ipsen, Janssen, Merck Sharp & Dohme, Roche, and Spring Bank and has received research grants from Abbvie and Gilead. GND has served as advisor/lecturer for Abbvie, Bayer, Bristol-Myers Squibb, Gilead, Janssen, Novartis, and Roche and has received grant support from Bristol-Myers Squibb, Gilead, and Roche. VS has served as advisor/lecturer for Abbvie, Gilead, and Janssen and has received research grants from Abbvie and Gilead. FVB has served as advisor/lecturer for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck Sharp & Dohme, Novartis, and Roche; has received research grants from Bristol-Myers Squibb, Gilead, Janssen, Roche, and Siemens; and has served as consultant for Abbvie, Gilead, and Roche. MB has served as advisor/lecturer for Abbvie, Arbutus, Bristol-Myers Squibb, Gilead, Glaxo Smith-Kleine, Merck, Roche, and Spring Bank. JLC has served as advisor/lecturer for Abbvie, Bristol-Myers Squibb, Gilead, Janssen, and Merck. JG has served as advisor/lecturer for Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck Sharp & Dohme, and Roche and has received a research grant from Bristol-Myers Squibb. SM has served as advisor/lecturer for Abbvie, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, and Roche and has received grants from Bristol-Myers Squibb and Gilead. AL has served as lecturer for Gilead and MYR Pharmaceuticals. JV has served as advisor/lecturer for Abbvie, Bristol-Myers Squibb, Gilead, Merck Sharp & Dohme, Novartis, and Roche. CY has served as speaker's bureau and/or advisor for AbbVie, Bristol-Myers Squibb, Gilead, Merck, and Roche and has received a research grant from Bristol-Myers Squibb. RE has served as advisor/lecturer for Abbvie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Janssen, Merck, and Novartis. HLAJ has served as consultant for and has received grants from AbbVie, Arbutus, Bristol Myers Squibb, Enyo, Gilead Sciences, Janssen, Medimmune, Merck, Roche, Vir Biotechnology Inc., and Viroclinics. TB has served as advisor/consultant/lecturer for Abbvie, Alexion, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Janssen, Merck Sharp & Dohme/Merck, Novartis, Roche, and Vertex and has received research support from Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck Sharp & Dohme/Merck, Novartis, and Roche. PL has served as speaker’s bureau/advisor for Abbvie, Eiger, Bristol-Myers Squibb, Gilead, GlaxoSmithKline, Merck/ Merck Sharp & Dohme, MYR Pharma, and Roche. RI, MP, NG, RV, ML-G, BEH, SS, AK, and KG have nothing to declare. Please refer to the accompanying ICMJE disclosure forms for further details.