External validation of CAGE-B and SAGE-B scores for Asian chronic hepatitis B patients with well-controlled viremia by antivirals.

Ji, Jung Hyun; Park, Soo Young; Son, Won Jeong; Shin, Hye Jung; Lee, Hyein; Lee, Hye Won; Lee, Jae Seung; Kim, Seung Up; Park, Jun Yong; Kim, Do Young; Ahn, Sang Hoon; Kim, Beom Kyung

CAGE-B and SAGE-B scores, consisting of age and fibrotic burden as cirrhosis and/or liver stiffness, were recently proposed to predict hepatocellular carcinoma (HCC) risk among Caucasian chronic hepatitis B (CHB) patients undergoing long-term antiviral therapy. We externally validated their predictive performances among an independent cohort from Asia, compared to other conventional prediction models. We consecutively recruited CHB patients with well-controlled viremia (serum HBV-DNA<2,000 IU/ml) receiving antiviral therapy. Patients with decompensated cirrhosis or HCC at baseline were excluded. Among 1763 patients, CAGE-B score provided the highest Heagerty's integrated area under the curve (iAUC) (0.820), followed by SAGE-B (0.804), mREACH-B (0.800), CAMD (0.786), mPAGE-B (0.748), and PAGE-B (0.721) scores. CAGE-B score showed a significantly better performance than SAGE-B, CAMD, PAGE-B, and mPAGE-B scores, but was similar to mREACH-B. SAGE-B score also showed significantly better performance than mPAGE-B and PAGE-B, but was similar to CAMD and mREACH-B. According to CAGE-B score 0~5, 6~10, and ≥11, the annual HCC incidences were 0.18, 1.34, and 6.03 per 100 person-years, respectively (all p<0.001 between each pair). Likewise, by SAGE-B score 0~5, 6~10, and ≥11, those were 0.31, 1.49, and 8.96 per 100 person-years, respectively (all p<0.001 between each pair). Hence CAGE-B and SAGE-B scores showed acceptable predictive performances for Asian CHB patients undergoing antiviral therapy, with the higher performance by CAGE-B score. They show a trend toward better prognostic capability to predict HCC risk than previous models.