Lim Jihye, Chon Young Eun, Kim Mi Na, Lee Joo Ho, Hwang Seong Gyu, Lee Han Chu, Ha Yeonjung
Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Gyeonggi-do, Korea.
Cancers (Basel). 2021 Nov 9;13(22):5609. doi: 10.3390/cancers13225609.
Predicting hepatocellular carcinoma (HCC) in patients with chronic hepatitis B who received long-term therapy with potent nucleos(t)ide analogs is of utmost importance to refine the strategy for HCC surveillance.
We conducted a multicenter retrospective cohort study to validate the CAGE-B and SAGE-B scores, HCC prediction models developed for Caucasian patients receiving entecavir (ETV) or tenofovir (TFV) for >5 years. Consecutive patients who started ETV or TFV at two hospitals in Korea from January 2009 to December 2015 were identified. The prediction scores were calculated, and model performance was assessed using receiver operating characteristics (ROC) curves.
Among 1557 patients included, 57 (3.7%) patients had HCC during a median follow-up of 93 (95% confidence interval, 73-119) months. In the entire cohort, CAGE-B predicted HCC with an area under the ROC curve of 0.78 (95% CI, 0.72-0.84). Models that have "liver cirrhosis" in the calculation, such as AASL (0.79 (0.72-0.85)), CU-HCC (0.77 (0.72-0.82)), and GAG-HCC (0.79 (0.74-0.85)), showed accuracy similar to that of CAGE-B ( > 0.05); however, models without "liver cirrhosis", including SAGE-B (0.71 (0.65-0.78)), showed a lower predictive ability than CAGE-B. CAGE-B performed well in subgroups of patients treated without treatment modification (0.81 (0.73-0.88)) and of male sex (0.79 (0.71-0.86)).
This study validated the clinical usefulness of the CAGE-B score in a large number of Asian patients treated with long-term ETV or TFV. The results could provide the basis for the reappraisal of HCC surveillance strategies and encourage future prospective validation studies with liver stiffness measurements.
对于接受强效核苷（酸）类似物长期治疗的慢性乙型肝炎患者，预测肝细胞癌（HCC）对于完善HCC监测策略至关重要。
我们开展了一项多中心回顾性队列研究，以验证CAGE - B和SAGE - B评分，这是为接受恩替卡韦（ETV）或替诺福韦（TFV）治疗超过5年的白种人患者开发的HCC预测模型。确定了2009年1月至2015年12月在韩国两家医院开始使用ETV或TFV的连续患者。计算预测评分，并使用受试者工作特征（ROC）曲线评估模型性能。
在纳入的1557例患者中，57例（3.7%）患者在中位随访93（95%置信区间，73 - 119）个月期间发生了HCC。在整个队列中，CAGE - B预测HCC的ROC曲线下面积为0.78（95%CI，0.72 - 0.84）。在计算中包含“肝硬化”的模型，如AASL（0.79（0.72 - 0.85））、CU - HCC（0.77（0.72 - 0.82））和GAG - HCC（0.79（0.74 - 0.85）），显示出与CAGE - B相似的准确性（P>0.05）；然而，不包含“肝硬化”的模型，包括SAGE - B（0.71（0.65 - 0.78）），显示出比CAGE - B更低的预测能力。CAGE - B在未改变治疗的患者亚组（0.81（0.73 - 0.88））和男性患者亚组（0.79（0.71 - 0.86））中表现良好。
本研究验证了CAGE - B评分在大量接受长期ETV或TFV治疗的亚洲患者中的临床实用性。研究结果可为重新评估HCC监测策略提供依据，并鼓励未来开展结合肝脏硬度测量的前瞻性验证研究。
