PREDICTION OF HEPATOCELLULAR CARCINOMA THROUGH THE MODIFIED PAGE-B SCORE (MPAGE-B) IN PATIENTS WITH CHRONIC HEPATITIS B: IT SHOULD BE USED IN CLINICAL PRACTICE?

Abstract

•Chronic hepatitis B is a well-defined risk factor for hepatocellular carcinoma, and it is important to implement early detection programs for hepatocellular carcinoma in affected patients. In this study, the data found suggest that the mPAGE-B score can be applied to reduce the number of medical consultations in young patients infected with the hepatitis B virus and aged <40 years. Background - Persistent hepatitis B virus (HBV) infection can lead to hepatocellular carcinoma (HCC) alone, that is, without the development of previous cirrhosis, which makes it of paramount importance to predict the risk patients with chronic hepatitis B have for developing HCC in the future. Thus, the mPAGE-B score was developed in order to predict very low risks of HCC, becoming an important score, since with low risk, patient surveillance can be spread out. Objective - The main objective of this study was to predict the risk of HCC according to the mPAGE-B score for patients with chronic hepatitis B, using antiviral therapy. Results - A cross-sectional, descriptive, quantitative, and retrospective study was conducted. Patients with chronic hepatitis B from the Hepatology Outpatient Clinic of the Federal University of the Fronteira Sul/HCPF in Passo Fundo, Rio Grande do Sul, covering a period of 12 years, were analyzed. Results - Of the 67 patients submitted to data collection, the mean age at diagnosis was 51.4 (±12.1) years, with a predominance of males (76.1%-n.51). All patients were HBeAg negative at diagnosis and 11 (16.4%) had cirrhosis. Regarding the antiviral regimen, 70.1% used tenofovir disoproxil fumarate (TDF) and 29.9% entecavir (ETV). According to m-PAGE-B stratification, 18 (25%) patients were classified as low-risk, 30 (41.7%) as intermediate-risk, and 19 (26.4%) as high-risk of developing HCC. The probability of developing HCC of these 67 patients in 3 years was 0.4% for low, 2.8% for moderate, and 9% for high risk. In 5 years, the probability was 0.5% for low, 4.4% for moderate, and 14% for high risk. Conclusion - This study demonstrates that the mPAGE-B score can be applied to decrease the number of consultations of patients with chronic hepatitis B in specialized outpatient clinics and, based on this population, patients aged ≤40 years may have one consultation per year instead of semi-annual.