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Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B
Thodoris Voulgaris1, Margarita Papatheodoridi1, Pietro Lampertico2
1Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
Insights
This study systematically reviewed hepatocellular carcinoma (HCC) risk scores for chronic hepatitis B (CHB) patients. The PAGE-B and mPAGE-B scores demonstrated consistent predictability in diverse patient groups, suggesting their utility in clinical practice.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Hepatocellular carcinoma (HCC) is a significant concern in chronic hepatitis B (CHB) patients.
- Numerous risk scores have been developed to predict HCC incidence in CHB.
- A systematic assessment of these scores' performance is crucial for clinical application.
Purpose of the Study:
- To systematically evaluate the performance of existing hepatocellular carcinoma (HCC) risk scores in chronic hepatitis B (CHB) patients.
- To identify HCC risk scores with reliable predictive accuracy across different patient populations.
- To inform clinical decision-making regarding HCC surveillance in CHB.
Main Methods:
- A comprehensive literature search was conducted to identify studies on HCC risk score development and external validation in CHB patients.
- Performance metrics, including c-statistics and negative predictive values, were extracted and analyzed.
- Studies were categorized based on patient ethnicity (Asian, Caucasian/mixed) and treatment status.
Main Results:
- Twelve HCC risk scores were developed for untreated Asian patients and seven for treated Asian or Caucasian patients.
- Most scores showed significant predictive ability in their original cohorts (c-statistic: 0.76-0.95).
- External validation confirmed acceptable predictability in Asian cohorts (c-statistic: 0.70-0.86), with PAGE-B and mPAGE-B showing consistent performance across Asian and Caucasian/mixed cohorts.
Conclusions:
- PAGE-B and mPAGE-B scores exhibit robust predictability for HCC in treated Caucasian and/or Asian patients.
- These scores may aid in identifying CHB patients at low risk who might not require intensive surveillance.
- Further direct comparisons of HCC risk scores in diverse independent cohorts are warranted.
Background:
Several risk scores have been recently developed to predict hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. We systematically assessed the performance of the available HCC risk scores.
Methods:
Literature search was performed to identify all published studies reporting development or external validation of HCC risk scores in CHB patients.
Results:
Until March 2019, 12 scores were developed in untreated Asian and 7 scores in treated Asian (n = 6) or Caucasian (n = 1) patients. All scores provided significant predictions for HCC development in the derivation and validation cohorts of their original studies (c-statistic: 0.76-0.95) and usually classified patients into low, medium and high HCC risk groups. Eleven independent studies and three studies developing their own scores have validated externally some scores in Asian (GAG-HCC:5, CU-HCC:6, REACH-B:6, REACH-Bm:4, LSM-HCC:3, PAGE-B:5) or Caucasian/mixed origin patients (GAG-HCC:4, CU-HCC:4, REACH-B:4, PAGE-B:2). All scores offered acceptable predictability in almost all independent Asian cohorts (c-statistic: 0.70-0.86), but only PAGE-B and recently modified PAGE-B (mPAGE-B) offered good predictability in all independent Caucasian and/or Asian cohorts. Negative predictive values for 5-year HCC prediction were ≤99% (95%-99%) in most independent cohorts assessing Asian risk scores and 99%-100% in all independent cohorts (Caucasian/mixed origin:2; Asian:3) assessing PAGE-B and/or recently mPAGE-B.
Conclusions:
Direct comparison of the newest HCC risk scores in independent patient cohorts of different origin remains intriguing, although statistical associations may not be directly transferable to clinical practice. PAGE-B and recently mPAGE-B score seem to offer persistently high predictability for Caucasian and/or Asian treated patients with low HCC risk who require no surveillance.
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