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PAGE-B incorporating moderate HBV DNA levels predicts risk of HCC among patients entering into HBeAg-positive chronic hepatitis B
- Title
- PAGE-B incorporating moderate HBV DNA levels predicts risk of HCC among patients entering into HBeAg-positive chronic hepatitis B
- Authors
- Chun; Ho Soo; Papatheodoridis; George V.; Lee; Minjong; Hye Ah; Kim; Yeong Hwa; Seo Hyun; Oh; Yun-Seo; Park; Su Jin; Jihye; Han Ah; Hwi Young; Tae Hun; Yoon; Eileen L.; Jun; Dae Won; Ahn; Sang Hoon; Sypsa; Vana; Yurdaydin; Cihan; Lampertico; Pietro; Calleja; Jose Luis; Janssen; Harry LA.; Dalekos; George N.; Goulis; John; Berg; Thomas; Buti; Maria; Seung Up; Yoon Jun
- Ewha Authors
- 김태헌; 김휘영; 이민종; 이혜아; 전호수; 이한아
- SCOPUS Author ID
- 김태헌; 김휘영; 이민종; 이혜아; 전호수; 이한아
- Issue Date
- 2024
- Journal Title
- Journal of Hepatology
- ISSN
- 0168-8278
- Citation
- Journal of Hepatology vol. 80, no. 1, pp. 20 - 30
- Keywords
- HBeAg-positive chronic hepatitis B; HBeAg-positive chronic infection; hepatocellular carcinoma; risk prediction model
- Publisher
- Elsevier B.V.
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- Background & Aims: Recent studies reported that moderate HBV DNA levels are significantly associated with hepatocellular carcinoma (HCC) risk in hepatitis B e antigen (HBeAg)-positive, non-cirrhotic patients with chronic hepatitis B (CHB). We aimed to develop and validate a new risk score to predict HCC development using baseline moderate HBV DNA levels in patients entering into HBeAg-positive CHB from chronic infection. Methods: This multicenter cohort study recruited 3,585 HBeAg-positive, non-cirrhotic patients who started antiviral treatment with entecavir or tenofovir disoproxil fumarate at phase change into CHB from chronic infection in 23 tertiary university-affiliated hospitals of South Korea (2012–2020). A new HCC risk score (PAGED-B) was developed (training cohort, n = 2,367) based on multivariable Cox models. Internal validation using bootstrap sampling and external validation (validation cohort, n = 1,218) were performed. Results: Sixty (1.7%) patients developed HCC (median follow-up, 5.4 years). In the training cohort, age, gender, platelets, diabetes and moderate HBV DNA levels (5.00–7.99 log10 IU/ml) were independently associated with HCC development; the PAGED-B score (based on these five predictors) showed a time-dependent AUROC of 0.81 for the prediction of HCC development at 5 years. In the validation cohort, the AUROC of PAGED-B was 0.85, significantly higher than for other risk scores (PAGE-B, mPAGE-B, CAMD, and REAL-B). When stratified by the PAGED-B score, the HCC risk was significantly higher in high-risk patients than in low-risk patients (sub-distribution hazard ratio = 8.43 in the training and 11.59 in the validation cohorts, all p <0.001). Conclusions: The newly established PAGED-B score may enable risk stratification for HCC at the time of transition into HBeAg-positive CHB. Impact and implications: In this study, we developed and validated a new risk score to predict hepatocellular carcinoma (HCC) development in patients entering into hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) from chronic infection. The newly established PAGED-B score, which included baseline moderate HBV DNA levels (5–8 log10 IU/ml), improved on the predictive performance of prior risk scores. Based on a patient's age, gender, diabetic status, platelet count, and moderate DNA levels (5–8 log10 IU/ml) at the phase change into CHB from chronic infection, the PAGED-B score represents a reliable and easily available risk score to predict HCC development during the first 5 years of antiviral treatment in HBeAg-positive patients entering into CHB. With a scoring range from 0 to 12 points, the PAGED-B score significantly differentiated the 5-year HCC risk: low <7 points and high ≥7 points. © 2023 European Association for the Study of the Liver
- DOI
- 10.1016/j.jhep.2023.09.011
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
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