Modified PAGE-B score classifies HCC risk in patients undergoing HBV therapy

The PAGE-B score and a modified PAGE-B score identified which patients on antiviral therapy for chronic hepatitis B had a low risk for hepatocellular carcinoma development, according to published data.

Because the PAGE-B score — a risk prediction model based on age, sex, and platelet count — was developed among Caucasian patients on HBV antiviral therapy, Terry Cheuk-Fung Yip, PhD, from the Chinese University of Hong Kong, and colleagues developed the mPAGE-B score, modified slightly by Korean investigators to include serum albumin and weighted adjustment of age, sex, and platelet count.

“As these scores are based on objective demographic and laboratory parameters, they have the potential to be widely used in clinical practice,” they wrote.

The retrospective study comprised 32,150 patients with chronic HBV who received treatment with either Baraclude (entecavir, Bristol-Myers Squibb) or tenofovir disoproxil fumarate (TDF). During a median follow-up of 3.9 years, 4.8% of the cohort developed HCC.

Among the patients analyzed at baseline, 23,377 received entecavir or TDF for at least 2 years. The area under the receiver operating characteristic (AUROC) at 2 years of antiviral therapy to predict HCC development in the next 3 years was 0.78 (95% CI, 0.76-0.79) for PAGE-B and 0.81 (95% CI, 0.79-0.82) for mPAGE-B.

Investigators stratified patients in a low (21.3%), intermediate (47.6%), or high risk category (31.1%) based on PAGE-B scores at 2 years. At 3 years, 0.1% of those in the low risk group, 2% in the intermediate group, and 6% in the high risk group developed HCC (P < .001).

The mPAGE-B score presented similar percentage categories, with 23% in the low risk group, 42.1% in the intermediate group, and 34.9% in the high risk group. At 3 years, 0.1% in the low risk group, 1.4% in the intermediate group, and 7.1% in the high risk group developed HCC (P < .001).

Yip and colleagues noted that while most patients stayed in the same risk groups during the 2 years of treatment, those who improved to the low risk group from the intermediate group had a lower risk for HCC than those who remained in their baseline based on both the PAGE-B score (P = .007) and the mPAGE-B score (P = .058).

“Despite the development of numerous HCC risk scores for a decade, there are still controversies on how and when to apply these risk scores in clinical practice,” the researchers wrote. “The excellent performance of these two risk scores is very much in line with Korean and European experiences as reported in previous studies.” – by Talitha Bennett

Disclosures: Yip reports he has served as a speaker for Gilead Sciences.