George V. Papatheodoridis, Harry L.A. Janssen, Florian van Boemmel, Margarita Papatheodoridi, Anastasia Kourikou, Cihan Yurdaydin, Bettina E. Hansen, Pietro Lampertico, John Vlachogiannakos, Ramazan Idilman, Savvoula Savvidou, John Goulis, Marta López-Gómez, Spilios Manolakopoulos, Thomas Berg, Nikolaos K. Gatselis, Maria Buti, Jose Luis Calleja, Rafael Esteban, George N Dalekos, Rhea Veelken, Vana Sypsa, Kostas Galanis, Alessandro Loglio, Yurdaydın, Cihan (ORCID 0000-0002-5419-7158 & YÖK ID 189330), Papatheodoridis, George, V, Dalekos, George N., İdilman, Ramazan, Sypsa, Vana, Van Boemmel, Florian, Buti, Maria, Calleja, Jose Luis, Goulis, John, Manolakopoulos, Spilios, Loglio, Alessandro, Papatheodoridi, Margarita, Gatselis, Nikolaos, Veelken, Rhea, Lopez-Gomez, Marta, Hansen, Bettina E., Savvidou, Savvoula, Kourikou, Anastasia, Vlachogiannakos, John, Galanis, Kostas, Esteban, Rafael, Janssen, Harry L. A., Berg, Thomas, Lampertico, Pietro, School of Medicine, Institut Català de la Salut, [Papatheodoridis GV] Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens 'Laiko', Athens, Greece. [Dalekos GN] 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. [Idilman R] Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey. [Sypsa V] Department of Hygiene, Epidemiology & Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece. [Van Boemmel F] Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany. [Buti M, Esteban R] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Ciberehd, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, and Gastroenterology & Hepatology
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., Graphical abstract, Highlights • In treated Caucasian patients with chronic hepatitis B, newer Asian hepatocellular carcinoma risk scores offer good 5- and 10-year 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. • The addition of albumin in mPAGE-B does not seem to offer an advantage in patients with well-compensated liver disease.