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Hepatocellular carcinoma prediction beyond year 5 of oral therapy in a large cohort of Caucasian patients with chronic hepatitis B

Citation:

Papatheodoridis GV, Sypsa V, Dalekos G, Yurdaydin C, Van Boemmel F, Buti M, Calleja JL, Chi H, Goulis J, Manolakopoulos S, et al. Hepatocellular carcinoma prediction beyond year 5 of oral therapy in a large cohort of Caucasian patients with chronic hepatitis B. J Hepatol. 2020.

Abstract:

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) may develop in chronic hepatitis (CHB) patients even after 5 years of oral therapy and cannot be easily predicted. We assessed predictors and need for HCC surveillance in this setting. METHODS: Of 1951 adult Caucasians with CHB included in the PAGE-B cohort, 1427 (73%) have completed follow-up >5 years under therapy without HCC until year 5. Median follow-up has been 8.4 years from treatment onset. Points-based risk scores were developed to predict HCC risk after year 5. RESULTS: In years 5-12, HCC has been diagnosed in 33/1427 (2.3%) patients with cumulative incidence 2.4%, 3.2% and 3.8% at 8, 10 and 12 years, respectively. Older age or age >50 years, baseline cirrhosis and liver stiffness (LSM) >/=12 kPa at year 5 were independently associated with increased HCC risk. The HCC incidence was lower in non-cirrhotics than those with baseline cirrhosis and year-5 LSM <12 kPa than those with baseline cirrhosis and year-5 LSM >/=12 kPa. CAGE-B score was based on age at year 5 and baseline cirrhosis in relation to LSM at year 5 and SAGE-B score was based only on age and LSM at year 5 (c-index=0.809-0.814, 0.805-0.806 after bootstrap validation). Both scores offered 100% negative predictive values for HCC development in their low risk groups. CONCLUSIONS: In Caucasians with CHB, the HCC risk after the first 5 years of antiviral therapy depends on age, baseline cirrhosis status and LSM at year 5. CAGE-B and particularly SAGE-B represent simple and reliable risk scores for HCC prediction and surveillance beyond year 5 of therapy.

Notes:

Papatheodoridis, George VSypsa, VanaDalekos, George NYurdaydin, CihanVan Boemmel, FlorianButi, MariaCalleja, Jose LuisChi, HengGoulis, JohnManolakopoulos, SpiliosLoglio, AlessandroVoulgaris, TheodorosGatselis, NikolaosKeskin, OnurVeelken, RheaLopez-Gomez, MartaHansen, Bettina ESavvidou, SavvoulaKourikou, AnastasiaVlachogiannakos, JohnGalanis, KostasIdilman, RamazanEsteban, RafaelJanssen, Harry LABerg, ThomasLampertico, PietroengNetherlands2020/01/26 06:00J Hepatol. 2020 Jan 22. pii: S0168-8278(20)30022-2. doi: 10.1016/j.jhep.2020.01.007.