Predictive Performance of CAGE-B and SAGE-B Models in Asian Treatment-Naive Patients Who Started Entecavir for Chronic Hepatitis B

Chon, Hye Yeon; Lee, Jae Seung; Lee, Hye Won; Chun, Ho Soo; Kim, Seung Up; Tak, Won Young; Park, Jun Yong; Kweon, Young-Oh; Ahn, Sang Hoon; Jang, Se Young; Park, Soo Young

doi:10.1016/j.cgh.2021.06.001

Cited by 11 publications

(14 citation statements)

References 37 publications

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“…They are based on different combinations of LSM and several other parameters, such as age, gender, albumin, ALT, HBV-DNA, HBeAg, and they all show a good performance. 58 – 62 …”

Section: Prediction Of Clinical Outcomesmentioning

confidence: 99%

Update on the role of elastography in liver disease

Ferraioli

Roccarina

2022

Therap Adv Gastroenterol

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The diagnosis of liver fibrosis and the assessment of its severity are important to provide appropriate management, to determine the prognosis or the need for surveillance. Currently, for fibrosis staging, liver stiffness measurement (LSM) with the shear wave elastography (SWE) techniques is considered a reliable substitute for liver biopsy in several clinical scenarios. Nonetheless, it should be emphasized that stiffness value is a biomarker of diffuse liver disease that must be interpreted taking into consideration anamnesis, clinical and laboratory data. In patients with diffuse liver disease, it is more clinically relevant to determine the likelihood of advanced disease rather than to obtain an exact stage of liver fibrosis using a histologic classification. In this regard, a ‘rule of five’ for LSMs with vibration-controlled transient elastography (VCTE) and a ‘rule of four’ for LSMs with the acoustic radiation force impulse (ARFI)-based techniques have been proposed. In patients with advanced chronic liver disease (CLD), the risk of liver decompensation increases with increasing liver stiffness value. SWE has been proposed as a tool to predict the risk of death or complications in patients with CLD. LSM by VCTE combined with platelets count is a validated non-invasive method for varices screening, with very good results in terms of invasive procedures being spared. ARFI-based techniques also show some promising results in this setting. LSM, alone or combined in scores or algorithms with other parameters, is used to evaluate the risk of hepatocellular carcinoma occurrence. Due to the high prevalence of CLD, screening the population at risk is of interest but further studies are needed.

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“…They are based on different combinations of LSM and several other parameters, such as age, gender, albumin, ALT, HBV-DNA, HBeAg, and they all show a good performance. 58 – 62 …”

Section: Prediction Of Clinical Outcomesmentioning

confidence: 99%

Update on the role of elastography in liver disease

Ferraioli

Roccarina

2022

Therap Adv Gastroenterol

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“…Many models have been suggested to assess the risk stratification of HCC development in CHB patients [13][14][15]. Since the prognostic role of serum HBV DNA has weakened in the current era of potent NUCs, models established within one decade have adopted the presence of baseline cirrhosis and/or fibrosis parameters, rather than virological factors such as hepatitis B e-antigen (HBeAg) and/or serum HBV-DNA level [16][17][18][19][20][21][22][23]. This provides an overall superior prognostic performance to old models (i.e., REVEAL [24], CU-HCC [25], GAG-HCC [26], LSM-HCC [27], and REACH-B [28]), which primarily depend on virological factors.…”

Section: Introductionmentioning

confidence: 99%

Suboptimal Performance of Hepatocellular Carcinoma Prediction Models in Patients with Hepatitis B Virus-Related Cirrhosis

et al. 2022

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This study aimed to evaluate the predictive performance of pre-existing well-validated hepatocellular carcinoma (HCC) prediction models, established in patients with HBV-related cirrhosis who started potent antiviral therapy (AVT). We retrospectively reviewed the cases of 1339 treatment-naïve patients with HBV-related cirrhosis who started AVT (median period, 56.8 months). The scores of the pre-existing HCC risk prediction models were calculated at the time of AVT initiation. HCC developed in 211 patients (15.1%), and the cumulative probability of HCC development at 5 years was 14.6%. Multivariate Cox regression analysis revealed that older age (adjusted hazard ratio [aHR], 1.023), lower platelet count (aHR, 0.997), lower serum albumin level (aHR, 0.578), and greater LS value (aHR, 1.012) were associated with HCC development. Harrell’s c-indices of the PAGE-B, modified PAGE-B, modified REACH-B, CAMD, aMAP, HCC-RESCUE, AASL-HCC, Toronto HCC Risk Index, PLAN-B, APA-B, CAGE-B, and SAGE-B models were suboptimal in patients with HBV-related cirrhosis, ranging from 0.565 to 0.667. Nevertheless, almost all patients were well stratified into low-, intermediate-, or high-risk groups according to each model (all log-rank p < 0.05), except for HCC-RESCUE (p = 0.080). Since all low-risk patients had cirrhosis at baseline, they had unneglectable cumulative incidence of HCC development (5-year incidence, 4.9–7.5%). Pre-existing risk prediction models for patients with chronic hepatitis B showed suboptimal predictive performances for the assessment of HCC development in patients with HBV-related cirrhosis.

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“…Although THRI (Toronto HCC risk index) has shown good predictive ability for HCC in patients with cirrhosis [ 93 ], it was not superior to mPAGE-B in Korean CHB patients [ 91 ]. Meanwhile, the CAGE-B (cirrhosis and age) and SAGE-B (stiffness and age) models, which were developed from Western studies [ 94 ], has been validated by several Korean retrospective studies [ 95 , 96 ]. A recently developed FSAC (fibrosis marker response, sex, age, cirrhosis) model that incorporates on-therapy changes in non-invasive fibrosis markers (fibrosis-4 [FIB-4] or aspartate aminotransferase-to-platelet ratio index [APRI]) has been validated in a separate cohort of Korean CHB patients [ 97 ].…”

Section: Natural Historymentioning

confidence: 99%

KASL clinical practice guidelines for management of chronic hepatitis B

2022

Clin Mol Hepatol

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Predictive Performance of CAGE-B and SAGE-B Models in Asian Treatment-Naive Patients Who Started Entecavir for Chronic Hepatitis B

Cited by 11 publications

References 37 publications

Update on the role of elastography in liver disease

Update on the role of elastography in liver disease

Suboptimal Performance of Hepatocellular Carcinoma Prediction Models in Patients with Hepatitis B Virus-Related Cirrhosis

KASL clinical practice guidelines for management of chronic hepatitis B

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