PAGED-B score predicts HCC risk in patients entering into CHB

A novel risk score, PAGED-B, may be used to predict hepatocellular carcinoma (HCC) development at the time of transition into hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB), suggests a study.

A total of 3,585 HBeAg-positive, noncirrhotic patients who started antiviral treatment with entecavir or tenofovir disoproxil fumarate at phase change into CHB from chronic infection in 23 tertiary university-affiliated hospitals of South Korea (2012–2020) were included in this multicentre cohort study.

Researchers developed PAGED-B based on multivariable Cox models in a training cohort (n=2,367). They then carried out internal validation using bootstrap sampling and external validation (n=1,218).

Over a median follow-up of 5.4 years, 60 (1.7 percent) patients developed HCC. In the training cohort, HCC development correlated independently with age, gender, platelets, diabetes, and moderate HBV DNA levels (5.00–7.99 log₁₀ IU/ml). Based on these five predictors, the PAGED-B score showed a time-dependent AUROC of 0.81 for predicting HCC development at 5 years.

In the validation cohort, PAGED-B had an AUROC of 0.85, which was significantly higher than for other risk scores (PAGE-B, mPAGE-B, CAMD, and REAL-B).

A significantly higher risk of HCC was observed in high-risk patients than in low-risk patients when stratified by the PAGED-B score (training cohort: subdistribution hazard ratio [sHR], 8.43; validation cohort: 11.59; p<0.001 for all).

“Based on a patient’s age, gender, diabetic status, platelet count, and moderate DNA levels (5–8 log₁₀ IU/ml) at the phase change into CHB from chronic infection, the PAGED-B score represents a reliable and easily available risk score to predict HCC development during the first 5 years of antiviral treatment in HBeAg-positive patients entering into CHB,” the researchers said.