Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): Development and validation of a predictive score

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Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-:

Development and validation of a predictive score

The Lancet Oncology - Online First, 04/18/2011

Yang HI et al. – A simple-to-use risk score that uses baseline clinical

variables was developed and validated. The score accurately estimates the risk

of developing HCC at 3, 5, and 10 years in patients with chronic hepatitis B.

Clinicians can use this score to assess risk of HCC in patients with chronic

hepatitis B and subsequently make evidence-based decisions about their clinical

management.

Methods

•Development cohort consisted of 3584 patients without cirrhosis from

community-based Taiwanese REVEAL-HBV study (of whom 131 developed HCC during

follow-up), and validation cohort of 1505 patients from three hospitals in Hong

Kong and South Korea (of whom 111 developed HCC during follow-up)

•Used multivariate proportional hazards model to predict risk of HCC at 3,

5, and 10 years

•Variables included in risk score were sex, age, serum alanine aminotransferase

concentration, HBeAg status, and serum HBV DNA level

•Calculated area under receiver operating curve (AUROC) and calibration of

predicted and observed HCC risk

Results•17-point risk score developed, with HCC risk ranging from 0·0% to 23·6%

at 3 years, 0·0% to 47·4% at 5 years, and 0·0% to 81·6% at 10 years for patients

with lowest and highest HCC risk

•AUROCs to predict risk were 0·811 (95% CI 0·790—0·831) at 3 years, 0·796

(0·775—0·816) at 5 years, and 0·769 (0·747—0·790) at 10 years in validation

cohort, and 0·902 (0·884—0·918), 0·783 (0·759—0·806), and 0·806 (0·783—0·828)

after exclusion of 277 patients in validation cohort with cirrhosis

•Predicted risk well calibrated with Kaplan-Meier observed HCC risk

______________________________________________________________________________

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70077-8/abstra\

ct

The Lancet Oncology, Early Online Publication, 15 April 2011

doi:10.1016/S1470-2045(11)70077-8Cite or Link Using DOI

Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-:

development and validation of a predictive score

Hwai-I Yang PhD a b, Prof Man-Fung Yuen MD c, Prof Henry Lik-Yuen Chan MD d,

Prof Kwang-Hyub Han MD e, Prof Pei-Jer Chen MD f, Do-Young Kim MD e, Sang-Hoon

Ahn MD e, Prof Chien-Jen Chen ScD a g , Wai-Sun Wong MD d, Wai-Kay Seto

MBBS c, for the REACH-B Working Group

Summary

Background

Therapy for chronic hepatitis B reduces the risk of progressing to

hepatocellular carcinoma (HCC); however, there is no suitable and accurate means

to assess risk. This study aimed to develop and validate a simple scoring system

to predict HCC risk in patients with chronic hepatitis B.

Methods

The development cohort consisted of 3584 patients without cirrhosis from the

community-based Taiwanese REVEAL-HBV study (of whom 131 developed HCC during

follow-up), and a validation cohort of 1505 patients from three hospitals in

Hong Kong and South Korea (of whom 111 developed HCC during follow-up). We used

multivariate proportional hazards model to predict risk of HCC at 3, 5, and

10 years. Variables included in the risk score were sex, age, serum alanine

aminotransferase concentration, HBeAg status, and serum HBV DNA level. We

calculated the area under receiver operating curve (AUROC) and calibration of

predicted and observed HCC risk.

Findings

A 17-point risk score was developed, with HCC risk ranging from 0·0% to 23·6% at

3 years, 0·0% to 47·4% at 5 years, and 0·0% to 81·6% at 10 years for patients

with the lowest and highest HCC risk, respectively. AUROCs to predict risk were

0·811 (95% CI 0·790—0·831) at 3 years, 0·796 (0·775—0·816) at 5 years, and 0·769

(0·747—0·790) at 10 years in the validation cohort, and 0·902 (0·884—0·918),

0·783 (0·759—0·806), and 0·806 (0·783—0·828), respectively, after exclusion of

277 patients in the validation cohort with cirrhosis. Predicted risk was well

calibrated with Kaplan-Meier observed HCC risk.

Interpretation

A simple-to-use risk score that uses baseline clinical variables was developed

and validated. The score accurately estimates the risk of developing HCC at 3,

5, and 10 years in patients with chronic hepatitis B. Clinicians can use this

score to assess risk of HCC in patients with chronic hepatitis B and

subsequently make evidence-based decisions about their clinical management.

Funding

The Academia Sinica; the National Health Research Institute, Taiwan; and

Bristol-Myers Squibb.

[Guest guest]

http://www.mdlinx.com/gastroenterology/newsl-article.cfm/3565559/ZZ6806553679256\

39220014/?news_id=511 & newsdt=041811 & subspec_id=144

Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-:

Development and validation of a predictive score

The Lancet Oncology - Online First, 04/18/2011

Yang HI et al. – A simple-to-use risk score that uses baseline clinical

variables was developed and validated. The score accurately estimates the risk

of developing HCC at 3, 5, and 10 years in patients with chronic hepatitis B.

Clinicians can use this score to assess risk of HCC in patients with chronic

hepatitis B and subsequently make evidence-based decisions about their clinical

management.

Methods

•Development cohort consisted of 3584 patients without cirrhosis from

community-based Taiwanese REVEAL-HBV study (of whom 131 developed HCC during

follow-up), and validation cohort of 1505 patients from three hospitals in Hong

Kong and South Korea (of whom 111 developed HCC during follow-up)

•Used multivariate proportional hazards model to predict risk of HCC at 3,

5, and 10 years

•Variables included in risk score were sex, age, serum alanine aminotransferase

concentration, HBeAg status, and serum HBV DNA level

•Calculated area under receiver operating curve (AUROC) and calibration of

predicted and observed HCC risk

Results•17-point risk score developed, with HCC risk ranging from 0·0% to 23·6%

at 3 years, 0·0% to 47·4% at 5 years, and 0·0% to 81·6% at 10 years for patients

with lowest and highest HCC risk

•AUROCs to predict risk were 0·811 (95% CI 0·790—0·831) at 3 years, 0·796

(0·775—0·816) at 5 years, and 0·769 (0·747—0·790) at 10 years in validation

cohort, and 0·902 (0·884—0·918), 0·783 (0·759—0·806), and 0·806 (0·783—0·828)

after exclusion of 277 patients in validation cohort with cirrhosis

•Predicted risk well calibrated with Kaplan-Meier observed HCC risk

______________________________________________________________________________

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(11)70077-8/abstra\

ct

The Lancet Oncology, Early Online Publication, 15 April 2011

doi:10.1016/S1470-2045(11)70077-8Cite or Link Using DOI

Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-:

development and validation of a predictive score

Hwai-I Yang PhD a b, Prof Man-Fung Yuen MD c, Prof Henry Lik-Yuen Chan MD d,

Prof Kwang-Hyub Han MD e, Prof Pei-Jer Chen MD f, Do-Young Kim MD e, Sang-Hoon

Ahn MD e, Prof Chien-Jen Chen ScD a g , Wai-Sun Wong MD d, Wai-Kay Seto

MBBS c, for the REACH-B Working Group

Summary

Background

Therapy for chronic hepatitis B reduces the risk of progressing to

hepatocellular carcinoma (HCC); however, there is no suitable and accurate means

to assess risk. This study aimed to develop and validate a simple scoring system

to predict HCC risk in patients with chronic hepatitis B.

Methods

The development cohort consisted of 3584 patients without cirrhosis from the

community-based Taiwanese REVEAL-HBV study (of whom 131 developed HCC during

follow-up), and a validation cohort of 1505 patients from three hospitals in

Hong Kong and South Korea (of whom 111 developed HCC during follow-up). We used

multivariate proportional hazards model to predict risk of HCC at 3, 5, and

10 years. Variables included in the risk score were sex, age, serum alanine

aminotransferase concentration, HBeAg status, and serum HBV DNA level. We

calculated the area under receiver operating curve (AUROC) and calibration of

predicted and observed HCC risk.

Findings

A 17-point risk score was developed, with HCC risk ranging from 0·0% to 23·6% at

3 years, 0·0% to 47·4% at 5 years, and 0·0% to 81·6% at 10 years for patients

with the lowest and highest HCC risk, respectively. AUROCs to predict risk were

0·811 (95% CI 0·790—0·831) at 3 years, 0·796 (0·775—0·816) at 5 years, and 0·769

(0·747—0·790) at 10 years in the validation cohort, and 0·902 (0·884—0·918),

0·783 (0·759—0·806), and 0·806 (0·783—0·828), respectively, after exclusion of

277 patients in the validation cohort with cirrhosis. Predicted risk was well

calibrated with Kaplan-Meier observed HCC risk.

Interpretation

A simple-to-use risk score that uses baseline clinical variables was developed

and validated. The score accurately estimates the risk of developing HCC at 3,

5, and 10 years in patients with chronic hepatitis B. Clinicians can use this

score to assess risk of HCC in patients with chronic hepatitis B and

subsequently make evidence-based decisions about their clinical management.

Funding

The Academia Sinica; the National Health Research Institute, Taiwan; and

Bristol-Myers Squibb.