External validation of the modified PAGE‐B score in Asian chronic hepatitis B patients receiving antiviral therapy

• Published in: Liver international 2019-09, Vol.39 (9), p.1624-1630
• Main Authors: Lee, Hye Won, Kim, Seung Up, Park, Jun Yong, Kim, Do Young, Ahn, Sang Hoon, Han, Kwang‐Hyub, Kim, Beom Kyung
• Format: Article
• Language: English
• Subjects: Albumin; Albumins; Antiviral agents; Cirrhosis; comparison; Hepatitis; Hepatitis B; Hepatocellular carcinoma; Interferon; Lamivudine; Liver cirrhosis; modified PAGE‐B; Performance prediction; prediction; Prediction models; Risk; Subgroups; Tenofovir; validation
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.14129

Background and Aims The modified PAGE‐B (mPAGE‐B) score comprising age, gender, platelet count and albumin was recently proposed to predict hepatocellular carcinoma (HCC) risk among chronic hepatitis B (CHB) patients undergoing antivirals. Here, in the independent cohort, we externally validated the predictive performance of the mPAGE‐B score and compared it with those of conventional HCC prediction models. Methods We consecutively recruited CHB patients treated with lamivudine, entecavir or tenofovir as the first‐line antiviral regimen. Patients with decompensated cirrhosis or HCC at baseline were excluded. Predictive performances of the mPAGE‐B score and other models were assessed with comparison. Results Among 1330 patients, 9.6% developed HCC during follow‐up. The mPAGE‐B score provided the highest Harrell's c‐index (0.769), followed by the GAG‐HCC (0.751), PAGE (0.744), REACH‐B (0.686) and CU‐HCC (0.618) scores. The mPAGE‐B score showed the similar performance to the PAGE‐B and GAG‐HCC scores and the better performance than the REACH‐B and CU‐HCC scores. Cumulative HCC probabilities at 5‐ and 7‐years were 0.0% and 0.0% in low‐risk group (mPAGE‐B score ≤ 8), 6.1% and 10.8% in intermediate‐risk group (mPAGE‐B score 9‐12) and 18.7% and 26.7% in high‐risk group (mPAGE‐B score ≥ 13) respectively (both P