Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Departments of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Aliment Pharmacol Ther. 2021 Apr;53(8):919-927. doi: 10.1111/apt.16267. Epub 2021 Jan 19.
The modified PAGE-B (mPAGE-B) and PAGE-B models reliably predict the risk of developing chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC).
AIM(S): To investigate whether the addition of liver stiffness (LS) value, assessed using transient elastography, enhanced the predictive accuracies of these models METHODS: Patients with CHB who started anti-viral therapy (AVT) between 2007 and 2017 were enrolled. The training (Yonsei University Hospital) and validation (seven Korean referral institutes) cohorts contained 1211 and 973 patients, respectively.
Based on multivariate analysis, older age (hazard ratio [HR] = 1.051, 95% confidence interval [CI] = 1.031-1.071), male sex (HR = 2.265, 95% CI = 1.463-3.506), lower platelet count (HR = 0.993, 95% CI = 0.989-0.997) and greater LS values (HR = 1.015, 95% CI = 1.002-1.028) were independently associated with an increased risk of HCC development (all P < 0.05). Thus, we developed a modified PAGE -B model (maximum score 34) that included age, male sex, platelet count and LS value. The integrated area under the curve of the modified PAGE model was greater than those of the PAGE-B and mPAGE-B models (0.760 vs 0.714 and 0.716, respectively) in the derivation dataset. The cumulative HCC incidence was significantly higher in the high-risk (modified PAGE-B score ≥ 24) group than in the intermediate-risk (modified PAGE -B score 12-24) or low-risk (modified PAGE -B score < 12) group (all P < 0.001). Similar results were observed in the validation cohort.
The predictive accuracies of the PAGE-B and mPAGE-B models were validated in Korean patients with CHB receiving AVT. However, the modified PAGE -B model featuring the addition of LS value showed higher predictability than the PAGE-B and mPAGE-B models.
改良 PAGE-B（mPAGE-B）和 PAGE-B 模型可可靠地预测发生慢性乙型肝炎（CHB）相关肝细胞癌（HCC）的风险。
研究使用瞬时弹性成像评估肝硬度（LS）值是否能提高这些模型的预测准确性。
纳入 2007 年至 2017 年开始抗病毒治疗（AVT）的 CHB 患者。训练（延世大学医院）和验证（7 家韩国转诊机构）队列分别包含 1211 例和 973 例患者。
基于多变量分析，年龄较大（危险比 [HR] = 1.051，95%置信区间 [CI] = 1.031-1.071）、男性（HR = 2.265，95%CI = 1.463-3.506）、较低的血小板计数（HR = 0.993，95%CI = 0.989-0.997）和较高的 LS 值（HR = 1.015，95%CI = 1.002-1.028）与 HCC 发展风险增加独立相关（均 P < 0.05）。因此，我们开发了一个改良的 PAGE-B 模型（最高得分为 34 分），该模型包含年龄、性别、血小板计数和 LS 值。改良 PAGE 模型的综合曲线下面积大于 PAGE-B 和 mPAGE-B 模型（分别为 0.760、0.714 和 0.716）在推导数据集。高危（改良 PAGE-B 评分≥24）组的 HCC 累积发生率明显高于中危（改良 PAGE-B 评分 12-24）或低危（改良 PAGE-B 评分<12）组（均 P < 0.001）。验证队列也观察到了类似的结果。
改良 PAGE-B 和 mPAGE-B 模型在接受 AVT 的韩国 CHB 患者中的预测准确性得到验证。然而，改良的 PAGE-B 模型加入 LS 值后，其预测能力高于 PAGE-B 和 mPAGE-B 模型。
