Chon Hye Yeon, Lee Jae Seung, Lee Hye Won, Chun Ho Soo, Kim Beom Kyung, Tak Won Young, Park Jun Yong, Kweon Young-Oh, Kim Do Young, Ahn Sang Hoon, Jang Se Young, Park Soo Young, Kim Seung Up
Department of Internal Medicine, Yonsei University College of Medicine, Seoul; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul; Yonsei Liver Center, Severance Hospital, Seoul.
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.
Clin Gastroenterol Hepatol. 2022 Apr;20(4):e794-e807. doi: 10.1016/j.cgh.2021.06.001. Epub 2021 Jun 6.
BACKGROUND & AIMS: Cirrhosis and age (CAGE-B) and stiffness and age (SAGE-B) models assess the risk of hepatocellular carcinoma (HCC) development in white patients with chronic hepatitis B (CHB) undergoing sustained antiviral therapy (AVT). Herein, we checked the predictive performance of these models in Asian patients with CHB.
We reviewed 734 treatment-naive patients with CHB who started entecavir between 2006 and 2011 and were followed up for more than 5 years without HCC development during AVT. The predictive performance of CAGE-B and SAGE-B models was calculated using area under the receiver operating characteristic curves (AUROCs).
Median liver stiffness assessed using transient elastography after 5 years of AVT was 6.8 kPa. Median CAGE-B and SAGE-B models after 5 years of AVT were 7.0 and 6.0, respectively. More than 5 years after AVT initiation, 66 patients (9.0%) developed HCC. The AUROCs of the CAGE-B and SAGE-B models were 0.764 and 0.785 after 7 years and 0.799 and 0.802 after 10 years of AVT, respectively. The cumulative incidence of HCC was significantly higher in the high-risk groups according to CAGE-B and SAGE-B risk stratification than in the medium- and low-risk groups (P < .05 in all cases). The SAGE-B model showed a higher likelihood ratio (χ) (76.2 vs 71.4) and linear trend (χ) (74.1 vs 58.6) than the CAGE-B model, whereas the CAGE-B model showed higher Akaike information criteria (64.3 vs 50.3).
Both SAGE-B and CAGE-B showed acceptable performance in predicting HCC after 5 years of AVT in Asian patients with CHB.
肝硬化与年龄（CAGE - B）模型和硬度与年龄（SAGE - B）模型用于评估接受持续抗病毒治疗（AVT）的慢性乙型肝炎（CHB）白人患者发生肝细胞癌（HCC）的风险。在此，我们检验了这些模型在亚洲CHB患者中的预测性能。
我们回顾了734例初治CHB患者，这些患者于2006年至2011年间开始使用恩替卡韦，并在AVT期间接受了超过5年的随访且未发生HCC。使用受试者工作特征曲线下面积（AUROCs）计算CAGE - B和SAGE - B模型的预测性能。
AVT 5年后使用瞬时弹性成像评估的肝脏硬度中位数为6.8 kPa。AVT 5年后CAGE - B和SAGE - B模型的中位数分别为7.0和6.0。开始AVT超过5年后，66例患者（9.0%）发生了HCC。AVT 7年后CAGE - B和SAGE - B模型的AUROCs分别为0.764和0.785，AVT 10年后分别为0.799和0.802。根据CAGE - B和SAGE - B风险分层，高危组HCC的累积发病率显著高于中、低危组（所有情况P <.05）。SAGE - B模型显示出比CAGE - B模型更高的似然比（χ）（76.2对71.4）和线性趋势（χ）（74.1对58.6），而CAGE - B模型显示出更高的赤池信息准则（64.3对50.3）。
在亚洲CHB患者中，SAGE - B和CAGE - B在预测AVT 5年后的HCC方面均表现出可接受的性能。
