Kyu Sik Jung MD1, Seung Up Kim MD, PhD1,2, Kijun Song PhD3, Jun Yong Park MD, PhD1,2, Do Young Kim MD, PhD1,2, Sang Hoon Ahn MD, PhD1,2,4, Beom Kyung Kim MD, PhD1,2,* and Kwang-Hyub Han MD1,2,4,*
1 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
2 Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
3 Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
4 Brain Korea 21 Project of Medical Science, Seoul, Republic of Korea
*Corresponding author: Beom Kyung Kim, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea, Kwang-Hyub Han, MD, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea,
Abstracts
Several risk prediction models have been created to predict hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) occurrence, with promising results. However, their prognostic performances need to be validated in the era of antiviral therapy. From 2006 to 2011, patients with chronic HBV infection were recruited and those with a history of HCC or hepatic decompensation were excluded. At enrollment, liver stiffness (LS) was measured using transient elastography. We assessed the performances of conventional HCC prediction models (CU-HCC, GAG-HCC, REACH-B, and LSM-HCC scores) and the modified REACH-B (mREACH-B) score where LS values were incorporated into REACH-B score instead of serum HBV-DNA levels. Of 1308 subjects analyzed, the median age was 50.0 years (883 men). During the follow-up (median 75.3 months), HCC developed in 125 (9.6%) patients. mREACH-B score had the highest areas under the receiver-operating characteristic curves (AUROCs) for the prediction of HCC development at 3-/5-years (0.828/0.806), compared with LSM-HCC (0.777/0.759), GAG-HCC (0.751/0.757), REACH-B (0.717/0.699), and CU-HCC (0.698/0.700) scores respectively, with statistical significances (all p-value<0.05 vs. mREACH-B). When serum HBV-DNA levels were excluded from the formula for REACH-B score, AUROCs for HCC development at 3-/5-years improved paradoxically (from 0.717/0.699 to 0.757/0.732, respectively). In patients with antiviral therapy (n=848), mREACH-B score had the better prognostic performances for HCC development at 3-/5-years, compared to other prediction models. However, in patients without antiviral therapy (n=460), it had the prognostic performances comparable to those of other prediction models.
Conclusions: Prognostic performances of mREACH-B score seemed better compared to conventional models. In the era of antiviral therapy, the incorporation of serum HBV-DNA level should be applied cautiously and individual risks should be assessed effectively based on the fibrotic burden. This article is protected by copyright. All rights reserved.
Keywords : Hepatitis B virus; Chronic hepatitis B; Hepatocellular carcinoma; Liver stiffness measurement; Cirrhosis