Abstract
Recently, modified REACH-B (mREACH-B) risk prediction model for hepatocellular carcinoma (HCC) development was proposed. We validated the accuracy of the mREACH-B model and compared its accuracy with those of other prediction models. Between 2006 and 2012, 1,241 patients with chronic hepatitis B (CHB) were recruited. All patients underwent transient elastography at enrollment. The median age of the study population (840 males, 401 females) was 49 years. The median PAGE-B, LSM-HCC, and mREACH-B values were 10, 10, and 8, respectively. Among patients without cirrhosis (n = 940, 75.7%), the median REACH-B value was 9. During the follow-up period (median 77.4 months), 66 (5.3%) and 83 (6.7%) patients developed HCC and liver-related events (LRE), respectively. Higher liver stiffness (LS) independently predicted HCC (hazard ratio [HR] = 1.047) and LRE development (HR = 1.047) (all P < 0.05). The mREACH-B significantly predicted HCC (AUC = 0.824 at 3-year and 0.750 at 5-year) and LRE development (AUC = 0.782 at 3-year and 0.739 at 5-year) (all P < 0.001) and it performed similarly or significantly better than the PAGE-B and LSM-HCC (AUC = 0.715-0.809 at 3-year and 0.719-0.742 at 5-year for HCC; AUC = 0.704-0.777 at 3-year and 0.721-0.735 at 5-year for LRE). Among patients without cirrhosis, mREACH-B predicted HCC (AUC = 0.803 vs. 0.654-0.816 at 3-year and 0.684 vs. 0.639-0.738 at 5-year) and LRE development (AUC = 0.734 vs. 0.619-0.789 at 3-year and 0.674 vs. 0.626-0.729 at 5-year) similarly to PAGE-B, REACH-B, and LSM-HCC. mREACH-B appropriately predicted HCC and LRE development in patients with CHB and showed similar or superior accuracy to those of PAGE-B, REACH-B, and LSM-HCC.
Highlights
Chronic hepatitis B (CHB) virus infection is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC), especially in Asian countries, where chronic hepatitis B virus (HBV) infection is endemic [1, 2]
The mREACH-B significantly predicted HCC (AUC = 0.824 at 3-year and 0.750 at 5-year) and liver-related events (LRE) development (AUC = 0.782 at 3-year and 0.739 at 5-year) and it performed or significantly better than the PAGE-B and LSM-HCC (AUC = 0.715-0.809 at 3-year and 0.719-0.742 at 5-year for HCC; area under curve (AUC) = 0.704-0.777 at 3-year and 0.721-0.735 at 5-year for LRE)
Because REACH-B was established from the cohort of CHB patients without cirrhosis, it is not applicable to the whole spectrum of patients with CHB, such as those with cirrhosis, who are at higher risk of HCC development and may benefit most from risk stratification
Summary
Chronic hepatitis B (CHB) virus infection is a leading cause of liver cirrhosis and hepatocellular carcinoma (HCC), especially in Asian countries, where chronic hepatitis B virus (HBV) infection is endemic [1, 2]. Risk stratification and the early detection of HCC are of great importance in patients with CHB. Several risk prediction models including the REACH-B and PAGE-B models showing acceptable accuracy have been proposed [3]. The REACH-B model, which includes gender, age, alanine aminotransferase (ALT) level, hepatitis B e antigen (HBeAg) status, and HBV DNA level as variables, was proposed from an Asian multi-center study [3]. Because REACH-B was established from the cohort of CHB patients without cirrhosis, it is not applicable to the whole spectrum of patients with CHB, such as those with cirrhosis, who are at higher risk of HCC development and may benefit most from risk stratification. The prognostic accuracy of the PAGE-B model, which was established from Caucasian subjects with CHB [4], has not fully validated yet in Asian subjects
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