External validation of the modified PAGE-B score in Asian chronic hepatitis B patients receiving antiviral therapy

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Background and Aims: The modified PAGE-B (mPAGE-B) score comprising age, gender, platelet count and albumin was recently proposed to predict hepatocellular carcinoma (HCC) risk among chronic hepatitis B (CHB) patients undergoing antivirals. Here, in the independent cohort, we externally validated the predictive performance of the mPAGE-B score and compared it with those of conventional HCC prediction models. Methods: We consecutively recruited CHB patients treated with lamivudine, entecavir or tenofovir as the first-line antiviral regimen. Patients with decompensated cirrhosis or HCC at baseline were excluded. Predictive performances of the mPAGE-B score and other models were assessed with comparison. Results: Among 1330 patients, 9.6% developed HCC during follow-up. The mPAGE-B score provided the highest Harrell's c-index (0.769), followed by the GAG-HCC (0.751), PAGE (0.744), REACH-B (0.686) and CU-HCC (0.618) scores. The mPAGE-B score showed the similar performance to the PAGE-B and GAG-HCC scores and the better performance than the REACH-B and CU-HCC scores. Cumulative HCC probabilities at 5- and 7-years were 0.0% and 0.0% in low-risk group (mPAGE-B score ≤ 8), 6.1% and 10.8% in intermediate-risk group (mPAGE-B score 9-12) and 18.7% and 26.7% in high-risk group (mPAGE-B score ≥ 13) respectively (both P < 0.001 between adjacent two groups). C-indices of the mPAGE-B score were 0.785 and 0.724 among subgroups treated with entecavir or tenofovir (n = 1011) and with lamivudine (n = 319), respectively, which are overall similar to those of the PAGE-B score. Conclusion: The mPAGE-B score showed acceptable predictive performances. Compared to the PAGE-B score, addition of albumin as a constituent provided the marginal benefit.

Original languageEnglish
Pages (from-to)1624-1630
Number of pages7
JournalLiver International
Issue number9
Publication statusPublished - 2019 Sept 1

Bibliographical note

Funding Information:
Funding information This research was in part supported by a fund (2019-ER5102-00) by Research of Korea Centers for Disease Control and Prevention. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

All Science Journal Classification (ASJC) codes

  • Hepatology


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