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

TitleRisk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): Development and validation of a predictive score
Authors
Issue Date2011
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/j.lancetoncol
Citation
The Lancet Oncology, 2011, v. 12 n. 6, p. 568-574 How to Cite?
Abstract
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 Cox 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. © 2011 Elsevier Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/137376
ISSN
2013 Impact Factor: 24.725
ISI Accession Number ID
Funding AgencyGrant Number
Academia Sinica
National Health Research Institute, Taiwan
Bristol-Myers Squibb
Bristol-Myers Squibb (Singapore)
Department of Health, Executive Yuan, Taipei, Taiwan
Academia Sinica, Taipei, Taiwan
National Health Research Institute, Chunan, Taiwan
Bristol-Myers Squibb (Wallingford, CT, USA)
Funding Information:

The Academia Sinica; the National Health Research Institute, Taiwan; and Bristol-Myers Squibb.

References

 

DC FieldValueLanguage
dc.contributor.authorYang, HIen_HK
dc.contributor.authorYuen, MFen_HK
dc.contributor.authorChan, HLYen_HK
dc.contributor.authorHan, KHen_HK
dc.contributor.authorChen, PJen_HK
dc.contributor.authorKim, DYen_HK
dc.contributor.authorAhn, SHen_HK
dc.contributor.authorChen, CJen_HK
dc.contributor.authorWong, VWSen_HK
dc.contributor.authorSeto, WKen_HK
dc.date.accessioned2011-08-26T14:24:07Z-
dc.date.available2011-08-26T14:24:07Z-
dc.date.issued2011en_HK
dc.identifier.citationThe Lancet Oncology, 2011, v. 12 n. 6, p. 568-574en_HK
dc.identifier.issn1470-2045en_HK
dc.identifier.urihttp://hdl.handle.net/10722/137376-
dc.description.abstractBackground: 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 Cox 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. © 2011 Elsevier Ltd.en_HK
dc.languageengen_US
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/j.lancetoncolen_HK
dc.relation.ispartofThe Lancet Oncologyen_HK
dc.subject.meshCarcinoma, Hepatocellular - etiology-
dc.subject.meshHepatitis B, Chronic - complications-
dc.subject.meshLiver Neoplasms - etiology-
dc.subject.meshProportional Hazards Models-
dc.subject.meshROC Curve-
dc.titleRisk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): Development and validation of a predictive scoreen_HK
dc.typeArticleen_HK
dc.identifier.emailYuen, MF: mfyuen@hku.hken_HK
dc.identifier.emailSeto, WK: wkseto2@hku.hken_HK
dc.identifier.authorityYuen, MF=rp00479en_HK
dc.identifier.authoritySeto, WK=rp01659en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S1470-2045(11)70077-8en_HK
dc.identifier.pmid21497551en_HK
dc.identifier.scopuseid_2-s2.0-79957448464en_HK
dc.identifier.hkuros189829en_US
dc.identifier.hkuros213689-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79957448464&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume12en_HK
dc.identifier.issue6en_HK
dc.identifier.spage568en_HK
dc.identifier.epage574en_HK
dc.identifier.isiWOS:000291842400020-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridYang, HI=7406562384en_HK
dc.identifier.scopusauthoridYuen, MF=7102031955en_HK
dc.identifier.scopusauthoridChan, HLY=25722700100en_HK
dc.identifier.scopusauthoridHan, KH=7402963689en_HK
dc.identifier.scopusauthoridChen, PJ=7408354514en_HK
dc.identifier.scopusauthoridKim, DY=35271994900en_HK
dc.identifier.scopusauthoridAhn, SH=7401989551en_HK
dc.identifier.scopusauthoridChen, CJ=7501949372en_HK
dc.identifier.scopusauthoridWong, VWS=7202525502en_HK
dc.identifier.scopusauthoridSeto, WK=23390675900en_HK
dc.identifier.citeulike9195602-

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