Predictive performance of newer Asian hepatocellular carcinoma risk scores in treated Caucasians with chronic hepatitis B
George V. Papatheodoridis,
George N. Dalekos,
Ramazan Idilman,
Vana Sypsa,
Florian Van Boemmel,
Maria Buti,
Jose Luis Calleja,
John Goulis,
Spilios Manolakopoulos,
Alessandro Loglio,
Margarita Papatheodoridi,
Nikolaos Gatselis,
Rhea Veelken,
Marta Lopez-Gomez,
Bettina E. Hansen,
Savvoula Savvidou,
Anastasia Kourikou,
John Vlachogiannakos,
Kostas Galanis,
Cihan Yurdaydin,
Rafael Esteban,
Harry L.A. Janssen,
Thomas Berg,
Pietro Lampertico
Affiliations
George V. Papatheodoridis
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece; Corresponding author. Address: Department of Gastroenterology, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Street, 11527 Athens, Greece. Tel: +30-2132061115, Fax: +30-2107462601
George N. Dalekos
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
Ramazan Idilman
Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
Vana Sypsa
Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece
Florian Van Boemmel
Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
Maria Buti
Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
Jose Luis Calleja
Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain
John Goulis
4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
Spilios Manolakopoulos
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece; 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
Alessandro Loglio
Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Margarita Papatheodoridi
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
Nikolaos Gatselis
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
Rhea Veelken
Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
Marta Lopez-Gomez
Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain
Bettina E. Hansen
Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
Savvoula Savvidou
4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece
Anastasia Kourikou
2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Hippokratio”, Athens, Greece
John Vlachogiannakos
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens, Greece
Kostas Galanis
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
Cihan Yurdaydin
Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
Rafael Esteban
Hospital General Universitario Vall Hebron and Ciberehd, Barcelona, Spain
Harry L.A. Janssen
Liver Clinic, Toronto Western & General Hospital, University Health Network, Toronto, ON, Canada
Thomas Berg
Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
Pietro Lampertico
Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
Background & Aims: Recently, several risk scores for prediction of hepatocellular carcinoma (HCC) were developed in cohorts of treated Asian patients with chronic hepatitis B (CHB), but they have not been assessed in non-Asian patients. We evaluated the predictability and comparative utility of our PAGE-B and recent Asian HCC risk scores in nucleos(t)ide analogue (NA)-treated adult Caucasian patients with CHB, with or without well-documented compensated cirrhosis but not previous diagnosis of HCC. Methods: We included 1,951 patients treated with entecavir/tenofovir and followed up for a median of 7.6 years. The c-statistic was used to estimate the predictability of PAGE-B, HCC-Rescue, CAMD, mPAGE-B, and AASL score for HCC development within 5 or 10 years. The low- and high-risk group cut-offs were used for estimation of negative (NPV) and positive predictive values (PPV), respectively. Results: HCC developed in 103/1,951 (5.3%) patients during the first 5 years and in another 39/1,428 (2.7%) patients between years 5 and 10. The 3-, 5-, and 10-year cumulative HCC rates were 3.3%, 5.9%, and 9.6%, respectively. All scores offered good 5- and 10-year HCC prediction (c-statistic: 0.78–0.82). NPVs were always >99% (99.3–100%), whereas PPV ranged between 13% and 24%. Conclusions: In NA-treated Caucasian patients with CHB including compensated cirrhosis, HCC risk scores developed in NA-treated Asian patients offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. PAGE-B and mPAGE-B scores are simpler in clinical practice, as they do not require an accurate diagnosis of cirrhosis, but the addition of albumin in mPAGE-B score does not seem to offer an advantage in patients with well compensated liver disease. Lay summary: Several risk scores for prediction of hepatocellular carcinoma (HCC) were recently developed in cohorts of treated Asian patients with chronic hepatitis B (CHB). In Caucasian patients with CHB treated with oral antivirals, newer Asian HCC risk scores offer good 5- and 10-year HCC predictability, similar to that of PAGE-B. For clinical practice, PAGE-B and mPAGE-B scores are simpler, as they do not require an accurate diagnosis of cirrhosis.
