VALIDATION OF PREDICTION MODELS FOR HEPATITIS B VIRUS- RELATED HEPATOCELLULAR CARCINOMA BASED ON THE TYPE OF ANTIVIRAL AGENTS

초록

Background: In the HCC risk prediction model for patients with CHB using antiviral drugs, many studies have focused on patients using first-line drugs (ETV or TDF), while some have exclusively considered patients using ETV. Our goal is to compare predictive capabilities based on the types of antiviral agents, especially to analyze whether these models can also be applied in the TDF or TAF treatment group. Methods: Using a retrospective cohort of 2,090 CHB patients undergoing antiviral therapy (ETV = 1148, TDF = 692, TAF = 250), we assessed the performances of conventional HCC prediction models (PAGE-B, modified PAGE-B, REAL-B, CAMD, AALC, HCC rescue score) and the modified REACH-B (mREACH-B), CAMPAS, PAGEBLS using liver stiffness (LS) value. Results: During the follow-up (median, 56.5 months), HCC developed in 124 (5.9%) patients. REAL-B (0.77), CAMD (0.76), AALC (0.76), HCC rescue score (0.76) had higher areas under the receiver operating characteristic curves (AUC) for the prediction of HCC development compared with PAGE-B (0.70), respectively, with statistical significances (all P values < 0.05). Among models using LS value, the CAMPAS score (0.78) demonstrated the highest prediction performance compared with mREACH-B (0.72; P <0.01) and PAGE-BLS (0.75; P = 0.04). CAMPAS (0.77) and PAGE-BLS (0.78) showed the highest discrimination with AUCs in the ETV group in subgroups according to the type of antiviral agents. In contrast, the CAMPAS score (0.79) had the highest performance in the TDF group. The TAF group exhibited lower discrimination with AUC values ranging from 0.62 to 0.69 for conventional HCC prediction models, whereas the CAMPAS score still demonstrated a high prediction performance with 0.79. Conclusion: In this undergoing antiviral treatment, most HCC prediction models performed well even when applied during treatment with TDF or TAF, particularly REAL-B, CAMD, AALC, HCC rescue score, and CAMPAs model.