medwireNews: Korean researchers show that the PAGE-B model for prediction of hepatocellular carcinoma (HCC) risk has applicability in Asian patients with chronic hepatitis B virus (HBV) infection treated with entecavir or tenofovir disoproxil fumarate (TDF).
The model, which was developed in Caucasian patients and relies only on a patient’s age, gender, and platelet count, performed as well as or better than conventional risk prediction models, they report in Liver International.
Seung Up Kim, from Yonsei University College of Medicine in Seoul, and study co-authors explain that despite virologic suppression induced by antiviral therapy, “the risk of developing HCC cannot be completely eliminated,” highlighting the importance of identifying at-risk patients “using optimal risk factors and providing risk-adjusted surveillance strategies.”
Of 1092 patients who received entecavir or TDF for at least 12 months, 3.3% developed HCC over a median follow-up of 43.6 months.
The PAGE-B model, at the recommended cutoff of 10, identified individuals likely to develop HCC at 3 and 5 years with area under the receiver operating characteristic curve (AUC) values of 0.777 and 0.799, respectively.
This was comparable to the predictive ability of the GAG-HCC (Guide with Age, Gender, HBV DNA, Core Promoter Mutations and Cirrhosis-HCC) model, which – at a cutoff of 101 – had corresponding AUC values of 0.793 and 0.803, and the CU-HCC (Chinese University-HCC) model, with AUCs of 0.743 and 0.744, respectively, at a cutoff of 5.
And the PAGE-B model performed significantly better than the REACH-B (Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B) model with a cutoff of 8, the AUCs for which were 0.602 at 3 years (p=0.029) and 0.572 at 5 years (p<0.001).
Noting that “PAGE-B can be used in resource-limited settings because it does not require an HBV-DNA titre or a detailed assessment of fibrotic burden, such as transient elastography, which are not universally available or affordable,” the investigators anticipate wide uptake of the model, especially in developing countries.
However, they note that “[f]uture validation studies are required to evaluate the applicability of these models in [chronic HBV] patients without antiviral therapy or in those treated with other low-genetic-barrier agents.”
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