Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2022; 28(6): 665-674
Published online Feb 14, 2022. doi: 10.3748/wjg.v28.i6.665
Validation of the PAGE-B score to predict hepatocellular carcinoma risk in caucasian chronic hepatitis B patients on treatment
Pinar Gokcen, Fatih Guzelbulut, Gupse Adali, Ayca Gokce Degirmenci Salturk, Oguzhan Ozturk, Ozgur Bahadir, Emine Kanatsiz, Mevlut Kiyak, Kamil Ozdil, Hamdi Levent Doganay
Pinar Gokcen, Gupse Adali, Oguzhan Ozturk, Kamil Ozdil, Hamdi Levent Doganay, Department of Gastroenterology, Health Sciences University, Umraniye Teaching and Research Hospital, Istanbul 34764, Turkey
Fatih Guzelbulut, Ayca Gokce Degirmenci Salturk, Ozgur Bahadir, Emine Kanatsiz, Mevlut Kiyak, Department of Gastroenterology, Health Sciences University, Haydarpasa Numune Teaching and Research Hospital, Istanbul 34668, Turkey
Author contributions: Doganay HL and Guzelbulut F equally contributed to this work. Doganay HL, Gokcen P, and Guzelbulut F contributed to the concept; Doganay HL, Gokcen P, Adali G, and Guzelbulut F designed this study; Doganay HL and Guzelbulut F supervised this study; Gokcen P, Kiyak M, Kanatsiz E, Bahadir O, Ozturk O and Ozdil K prepare the materials; Gokcen P, Guzelbulut F, Degirmenci Salturk AG, Kanatsiz E, Kiyak M, Ozturk O and Ozdil K collected and/or processed the data; Gokcen P, Doganay HL, Guzelbulut F and Adali G analyzed and/or interpreted the data; Gokcen P, Guzelbulut F., Kanatsiz E, Kiyak M, Degirmenci Salturk AG and Bahadir O searched the literature; Gokcen P, Doganay HL, Adali G and Guzelbulut F wrote the Manuscript; Doganay HL, Guzelbulut F and Adali G contributed to review critical.
Institutional review board statement: The study was approved by the local ethics committees of Umraniye Training and Research Hospital and Haydarpasa Numune Training and Research Hospital.
Conflict-of-interest statement: The authors report no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE guidelines, and the manuscript was prepared and revised according to the STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hamdi Levent Doganay, MD, Professor, Department of Gastroenterology, Health Sciences University, Umraniye Teaching and Research Hospital, No. 1 Adem Yavuz Street, Elmalikent, Umraniye, Istanbul 34764, Turkey.ldoganay@hotmail.com
Received: June 20, 2021
Peer-review started: June 20, 2021
First decision: July 14, 2021
Revised: July 27, 2021
Accepted: January 19, 2021
Article in press: January 19, 2022
Published online: February 14, 2022
Processing time: 233 Days and 12.2 Hours
Abstract
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 P < 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 P < 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.

Keywords: Chronic hepatitis B, Hepatocellular carcinoma, PAGE-B score, Surveillance

Core Tip: We evaluated the accuracy of the PAGE-B score in predicting hepatocellular carcinoma (HCC) risk in Turkish patients with chronic hepatitis B on antiviral treatment. The cumulative HCC incidences at 5 and 10 years were 0% and 0.4%, 1.5% and 2.1%, and 12.5% and 15.0% in the low-, moderate- and high-risk groups based on the PAGE-B score, respectively. The area under the receiver operating characteristics of the PAGE-B score in the prediction of HCC risk at 5 and 10 years were 0.903 and 0.865, respectively. The PAGE-B score was found to be highly negative predictive and reliable for a cutoff value of ≤ 9 in predicting HCC development.