PAGE-B评分对接受治疗的白种人慢性乙型肝炎患者肝细胞癌风险预测的验证
Validation of the PAGE-B score to predict hepatocellular carcinoma risk in caucasian chronic hepatitis B patients on treatment.
作者信息
Gokcen Pinar, Guzelbulut Fatih, Adali Gupse, Degirmenci Salturk Ayca Gokce, Ozturk Oguzhan, Bahadir Ozgur, Kanatsiz Emine, Kiyak Mevlut, Ozdil Kamil, Doganay Hamdi Levent
机构信息
Department of Gastroenterology, Health Sciences University, Umraniye Teaching and Research Hospital, Istanbul 34764, Turkey.
Department of Gastroenterology, Health Sciences University, Haydarpasa Numune Teaching and Research Hospital, Istanbul 34668, Turkey.
出版信息
World J Gastroenterol. 2022 Feb 14;28(6):665-674. doi: 10.3748/wjg.v28.i6.665.
BACKGROUND
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.
AIM
We aimed to evaluate the PAGE-B score in predicting HCC risk in Turkish CHB patients on antiviral treatment.
METHODS
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.
RESULTS
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 < 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 < 0.05).
CONCLUSION
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.
背景
已经开发了几种风险评分系统来预测慢性乙型肝炎（CHB）患者发生肝细胞癌（HCC）的风险。大多数风险评分基于治疗前变量，然而在大多数患者接受强效抗病毒治疗的早期，由于乙肝病毒复制受到抑制，这些变量不再被视为HCC发生的风险因素。基于血小板水平、年龄和性别的PAGE - B评分，已被证明能够准确预测不同人群中接受抗病毒治疗的CHB患者发生HCC的风险。
目的
我们旨在评估PAGE - B评分在预测接受抗病毒治疗的土耳其CHB患者发生HCC风险中的作用。
方法
在本研究中，我们招募了742例接受富马酸替诺福韦二吡呋酯或恩替卡韦治疗≥1年的CHB患者。根据PAGE - B评分确定风险组如下：≤9分为低风险；10 - 17分为中度风险；≥18分为高风险。使用Kaplan - Meier分析计算每个风险组的累积HCC发病率，并使用对数秩检验进行比较。在所有研究时间点，使用受试者操作特征曲线（AUROC）下的时间依赖性面积评估PAGE - B评分预测HCC风险的准确性。采用单因素和多因素逻辑回归分析评估HCC发生的风险因素。
结果
平均随访时间为54.7±1.2个月。26例患者（3.5%）被诊断为HCC。PAGE - B低风险组1年、3年、5年和10年的累积HCC发病率分别为0%、0%、0%和0.4%；PAGE - B中度风险组分别为0%、1.2%、1.5%和2.1%；PAGE - B高风险组分别为5%、11.7%、12.5%和15%（对数秩检验P<0.001）。PAGE - B评分在预测1年、3年、5年和10年HCC发生时的AUROC分别为0.977、0.903、0.903和0.865。在多变量分析中，年龄较大、男性、血小板水平较低、存在肝硬化以及在第6个月时丙氨酸氨基转移酶未恢复正常与HCC发生相关（均P<0.05）。
结论
PAGE - B评分是预测土耳其CHB患者发生HCC风险的实用工具，可能有助于改进监测策略。
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