Comparison of Risk Prediction Model for Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Cir rhosis Receiving Antiviral Therapy = Comparison of Risk Prediction Model for Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Cir rhosis Receiving Antiviral Therapy

다국어 초록 (Multilingual Abstract)

Aims: Various models for the prediction of hepatocellular carcinoma (HCC) in the patients with chronic hepatitis B (CHB) were suggested. The aim of study is to identify if the HCC risk scores are improved as antiviral therapy is prolonged in the patients with CHB-related liver cirrhosis.
Methods: The patients with CHB who received entecavir (ETV) or tenofovir (TDF) were investigated retrospectively. Patients with liver cirrhosis patients diagnosed by sonography, CT or biopsy were enrolled. We calculated the HCC risk scores at pre-antiviral therapy, and each year from year 1 to 5 of post-antiviral therapy. The models were GAG-HCC, CU-HCC, REACH-B, modified REACH-B (mREACH-B), LSM-HCC, and PAGE-B. The primary endpoint was decrease of the risk scores after antiviral therapy. The secondary endpoint was finding the best model by AUROC after antiviral therapy.
Results: A total of 362 patients were enrolled, and 198 and 164 patients were treated by ETV and TDF respectively. Child- Pugh scores were 5.7±1.3 and MELD were 9.9±3.8. Fifty six patient (15.5 %) occurred HCC at median 1.6 years (0.1-9.7 years). Most HCC scores (GAG, CU-HCC, REACH-B) decreased at year 1 and plateaued from year 1 to 5. mREACH-B and LSM-HCC scores decreased until year 2 and plateaued after year 2. PAGE-B showed no decrease from pre to post-antiviral therapy. The AUROC of PAGE-B was largest at baseline (GAG-HCC 0.472, CU-HCC 0.753, REACH-B 0.633, mREACH-B 0.688, LSM-HCC 0.649, and PAGE-B 0.760). After antiviral therapy, the AUROC changed. AUROCs of models employing HBV DNA levels increased (GAG-HCC, REACH-B, and LSM-HCC), that of liver stiffness based models (mREACH-B and PAGE-B) were persistent, and that of models employing hepatic function (CU-HCC) decreased (GAG-HCC 0.582, CU-HCC 0.686, REACH-B 0.689, mREACH-B 0.689, LSM-HCC 0.716, and PAGE-B 0.755 at 1year). The decrease of scores from baseline to each years were not different between ETV and TDF (all P>0.05). AUROC were largest in PAGE-B, however the scores were not changed after antiviral therapy. Second largest AUROC is that of LSM-HCC at year 1 and its AUROC became larger after antiviral therapy
Conclusions: In conclusion, HCC prediction models such as PAGE-B and LSM-based models worked well in patients with HBV-related cirrhosis and decrease of the scores was associated with effects of the antiviral therapy.