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
ARTICLE HIGHLIGHTS
Research background

Chronic hepatitis B (CHB) infection is an important health issue worldwide. Novel antiviral treatments lead to complete suppression of the virus and maintained suppression of viral replication prevents cirrhosis, decompensation in already cirrhotic patients and hepatocellular carcinoma (HCC). However, HCC risk is not totally eliminated and in pursuance of detecting cancer in early stages comprehensive follow up is needed. It is critical to stratify patients for risk predictions, especially to prevent unnecessary tests in low-risk patients.

Research motivation

Various risk scores have been developed to predict the development of HCC in CHB patients. The majority of studies on the risk scores had focused on untreated patients. Currently, almost all patients with CHB are treated with antiviral agents and better risk scores for patients under treatment is needed. The PAGE-B is a risk scoring system that includes platelet count, age and sex and has been validated in patients treated with antivirals.

Research objectives

We aimed to evaluate the accuracy of the PAGE-B scoring system in the prediction of HCC risk in CHB patients receiving entecavir (ETV) or tenofovir disoproxil fumarat therapy.

Research methods

We recruited 742 CHB patients who had been treated with tenofovir disoproxil fumarate or ETV for more than 1 year. Risk groups were determined according to the PAGE-B scores. We evaluated the accuracy of the PAGE-B score in predicting HCC.

Research results

HCC was diagnosed in 26 patients (3.5%) during 54.7 ± 1.2 mo mean follow up. The cumulative HCC incidences at 5 years were 0% in the PAGE-B low-risk group; 1.5% moderate-risk group; and 12.5%, in the high-risk group (log-rank p < 0.001). The AUROCs of the PAGE-B score in the prediction of HCC development at 5 years follow up was 0.903.

Research conclusions

PAGE–B had successfully predicted the patients who had a low risk of HCC during treatment with genetically high barrier antivirals.

Research perspectives

PAGE-B is a simple score that does not require biopsy or any impractical molecular test. The efficiency of PAGE-B justifies implementing this score in daily clinical practice.