Development of a scoring system to predict hepatocellular carcinoma in Asians on antivirals for chronic hepatitis B
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AbstractBackground & Aims
The risk of hepatocellular carcinoma (HCC) during antiviral therapy in patients with chronic hepatitis B (CHB) is inadequately predicted by the scores built from untreated patients. We aimed at developing and validating a risk score to predict HCC in patients with CHB on entecavir or tenofovir treatment.

This study analysed population-wide data from the healthcare databases in Taiwan and Hong Kong to identify patients with CHB continuously receiving entecavir or tenofovir. The development cohort included 23,851 patients from Taiwan; 596 (2.50%) of them developed HCC with a three-year cumulative incidence of 3.56% (95% CI 3.26–3.86%). The multivariable Cox proportional hazards model found that cirrhosis, age (cirrhosis and age interacted with each other), male sex, and diabetes mellitus were the risk determinants. These variables were weighted to develop the cirrhosis, age, male sex, and diabetes mellitus (CAMD) score ranging from 0 to 19 points. The score was externally validated in 19,321 patients from Hong Kong.

The c indices for HCC in the development cohort were 0.83 (95% CI 0.81–0.84), 0.82 (95% CI 0.81–0.84), and 0.82 (95% CI 0.80–0.83) at the first, second, and third years of therapy, respectively. In the validation cohort, the c indices were 0.74 (95% CI 0.71–0.77), 0.75 (95% CI 0.73–0.78), and 0.75 (95% CI 0.72–0.77) during the first three years, and 0.76 (95% CI 0.74–0.78) and 0.76 (95% CI 0.74–0.77) in the extrapolated fourth and fifth years, respectively. The predicted and observed probabilities of HCC were calibrated in both cohorts. A score <8 and >13 points identified patients at distinctly low and high risks.

The easily calculable CAMD score can predict HCC and may inform surveillance policy in patients with CHB during oral antiviral therapy.
All Author(s) ListHsu YC, Yip TC, Ho HJ, Wong VW, Huang YT, El-Serag HB, Lee TY, Wu MS, Lin JT, Wong GL, Wu CY.
Journal nameJournal of Hepatology
Detailed descriptionThe Erratum to this article has been published in Journal of Hepatology 2019 70:3 - "It has come to our attention that there are errors in Fig. 2 and Fig. 4 of this manuscript. The x-axis labels of the receiver operating characteristic curves in Fig. 2A,B and Fig. 4A,B should read ‘1-specificity’ rather than ‘specificity’. We sincerely apologize for this mistake."
Volume Number69
Issue Number2
Pages278 - 285
LanguagesEnglish-United Kingdom

Last updated on 2021-27-07 at 00:16