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Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
VALIDATION OF THE PAGE-B SCORE AS A PROGNOSIS OF DEVELOPMENT TO HEPATOCELLULAR CARCINOMA (HCC) IN CHRONIC HEPATITIS
Ingrid Laise Vivas Silva1, Liliane Lins-Kusterer2,3, Walter da Silva Júnior3
1Programa de Pós-Graduação em Processos Interativos de Órgãos e Sistemas - PPGPIOS-UFBA, Salvador, BA, Brasil.
Insights
The PAGE-B score effectively predicts hepatocellular carcinoma (HCC) risk in Brazilian hepatitis B virus (HBV) carriers. This validation supports its use for personalized HCC risk assessment in Brazil.
Area of Science:
- Hepatology
- Viral Hepatitis
- Oncology
Background:
- Chronic hepatitis B virus (HBV) infection poses risks of liver cirrhosis and hepatocellular carcinoma (HCC).
- Antiviral therapies like Tenofovir (TDF) and Entecavir (ETV) are crucial for managing HBV.
- The PAGE-B score aids in assessing HCC risk but requires validation in diverse populations, including Brazil.
Purpose of the Study:
- To validate the PAGE-B risk score for predicting HCC development in Brazilian HBV carriers.
- To examine the correlation between the PAGE-B score and patient demographics, laboratory results, and antiviral treatments.
Main Methods:
- A retrospective observational cohort study involving 659 individuals with chronic HBV mono-infection treated for at least 3 years.
- Analysis of the PAGE-B score's association with sex, age, and platelet count.
- Classification of HCC risk into low, moderate, and high categories.
Main Results:
- The mean PAGE-B score was 12.77±5.63, with 31.2% low, 43.5% moderate, and 25.3% high-risk patients.
- Hepatocellular carcinoma (HCC) developed in 4.7% of patients, a higher frequency than in other validation studies.
- HCC patients were predominantly male, older, with lower platelet counts and advanced fibrosis (F4 in 67.7%).
Conclusions:
- The PAGE-B score demonstrates comparable sensitivity, specificity, and predictive values for HCC risk in Brazilians versus European and Asian populations.
- The PAGE-B score is validated for use in the Brazilian population to predict HCC risk.
- This tool can aid in stratifying HBV carriers for personalized HCC surveillance and management.
Context:
Due to the potential risk for chronic and severe progression, hepatitis B virus (HBV) infection requires antiviral medications, such as Tenofovir (TDF) and Entecavir (ETV), to reduce the HBV viral load and prevent the risk of liver cirrhosis and hepatocellular carcinoma (HCC). The PAGE-B score is a simple and reliable tool for assessing the risk of developing HCC, although it has not yet been validated in Brazil.
Objective:
To validate the PAGE-B risk score for predicting HCC development in HBV carriers in Brazil. To analyze the association between the PAGE-B score and demographic, laboratory, and HBV treatment variables.
Methods:
An observational cohort. retrospective study. Study sample - 659 individuals with chronic HBV mono-infection treated with antivirals for at least 3 years at two reference centers in Brazil's Northeast and Amazon regions. The PAGE-B score was used to analyze its association with sex, age, and platelet count, classifying each patient's HCC risk as low, moderate, or high.
Results:
The mean PAGE-B score was 12.77±5.63. PAGE-B scores were classified as low, moderate, and high in 206 (31.2%), 287 (43.5%), and 166 (25.3%) individuals, respectively. Among the 659 patients, 31 (4.7%) developed HCC, a higher frequency than reported in PAGE-B score validation studies from other countries. Of these patients, 29 were male, with a mean age of 57.4±12.6 years and lower platelet levels (<200,000 10³/mL). Patients who developed HCC had fibrosis stages: F0-F1:6 (19.3%); F2:2 (6.4%); F3:2 (6.4%); and F4:21 (67.7%). High-risk patients were treated with ETV (n=129, 32%) versus TDF (n=37, 14,4%), P<0.00.
Conclusion:
The PAGE-B score demonstrated, in the Brazilian population, a performance similar to that observed in studies with European and Asian populations in terms of sensitivity, specificity, and predictive values for HCC prediction. Based on these results, the PAGE-B score can be used in the Brazilian population to predict the risk of HCC.
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