Accuracy of Risk Scores for Patients with Chronic Hepatitis B Receiving Entecavir Treatment
Menée à Hong Kong sur une cohorte de 1 531 patients atteints d'hépatite B chronique et recevant un traitement antiviral par voie orale, cette étude évalue la sensibilité et la spécificité de trois outils de prédiction du risque de carcinome hépatocellulaire
Little is known about the validity of hepatocellular carcinoma (HCC) risk scores derived from treatment-naïve patients with chronic hepatitis B for patients receiving entecavir. We performed a retrospective-prospective cohort study of 1531 patients with chronic hepatitis B (age, 51±12 years; 1099 male; 332 with clinical cirrhosis) who received entecavir (0.5 mg) daily for at least 12 months at the Prince of Wales Hospital in Hong Kong, from December 2005 to August 2012. The patients were assessed once every 3-6 months for symptoms, drug history, and adherence; blood samples were collected for biochemical analyses. We validated 3 HCC risk scores (CU-HCC, GAG-HCC, and REACH-B scores) based on data collected when patients began entecavir therapy and 2 years later. After 42±13 months of follow up, 47 patients (2.9%) developed HCC. The 5-year cumulative incidence of HCC was 4.3% (95% confidence interval [CI], 3.6%–5.0%). Old age, cirrhosis, and virologic remission after 24 months or more of therapy were independently associated with HCC in the entire cohort; advanced age and hypoalbuminemia were associated with HCC in patients without cirrhosis. The areas under receiver operating characteristic (AUC) curves for baseline CU-HCC, GAG-HCC, and REACH-B scores for HCC were 0.80 (95% CI, 0.75–0.86), 0.76 (95% CI, 0.70–0.82), and 0.71 (95% CI, 0.62–0.81) respectively; the time-dependent AUCs 1 to 4 years after patients started treatment were comparable to those at baseline. The cutoff value of the baseline CU-HCC score identified patients who would develop HCC with 93.6% sensitivity and 47.8% specificity, the baseline GAG-HCC score with 55.3% sensitivity and 78.9% specificity, and the baseline REACH-B score with 95.2% sensitivity and 16.5% specificity. Compared to patients with CU-HCC scores <5 at baseline, those with CU-HCC scores that either decreased from =5 to <5, or remained =5, had a higher risk of HCC (5-year cumulative incidences: 0% vs 3.9% and 7.3%; P =.002 and <.001 respectively). The CU-HCC, GAG-HCC, and REACH-B HCC risk scores accurately predict which patients with chronic hepatitis B treated with entecavir will develop HCC.
Gastroenterology , résumé, 2012