Performance of Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH‐B) score in classifying treatment eligibility under 2012 Asian Pacific Association for the Study of the Liver (APASL) guideline for chronic hepatitis B patients

• Published in: Alimentary pharmacology & therapeutics Vol. 37; no. 2; pp. 243 - 251
• Main Authors: Chen, T.‐M., Chang, C.‐C., Huang, P.‐T., Wen, C.‐F., Lin, C.‐C.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.01.2013
• Subjects: Adult; Age; Aged; Alanine Transaminase - blood; Antiviral agents; Antiviral Agents - therapeutic use; Biological and medical sciences; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - virology; Digestive system; DNA; DNA, Viral - analysis; Eligibility Determination; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B; hepatitis B e antigen; Hepatitis B e Antigens - analysis; Hepatitis B virus; Hepatitis B virus - genetics; Hepatitis B, Chronic - classification; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; Hepatocellular carcinoma; Human viral diseases; Humans; Infectious diseases; Liver Function Tests; Liver Neoplasms - diagnosis; Liver Neoplasms - etiology; Liver Neoplasms - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Logistic Models; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Regression analysis; Risk Assessment; Severity of Illness Index; Tumors; Viral diseases; Viral hepatitis; Performance evaluation; Human; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Recommendation; Infection; Viral hepatitis B; Liver cancer; Score; Treatment; Viral disease; Risk factor; Digestive diseases; Antiviral; Complication; Decision criterion; Cancer
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12144

Summary Background REACH‐B [Risk Estimation for Hepatocellular Carcinoma (HCC) in Chronic Hepatitis B] scoring system was developed to predict the risk of HCC in noncirrhotic chronic hepatitis B (CHB) patients. Aim To evaluate the discriminatory performance of REACH‐B scoring system in classifying anti‐viral treatment eligibility of CHB patients according to the 2012 Asian Pacific Association for the Study of the Liver (APASL) treatment guideline. Methods A total of 904 noncirrhotic CHB were enrolled. Patients' age, gender, liver biochemistry, HBeAg status and HBV DNA levels were recorded. Results The minimum REACH‐B risk score for patients to be eligible for anti‐viral treatment was 7 for HBeAg‐positive and 6 for HBeAg‐negative patients. Among them, increasing REACH‐B score was not significantly associated with eligibility for treatment [adjusted odds ratio (OR): 1.210, 95% confidence interval (CI): 0.979–1.494, P = 0.078] in HBeAg‐positive patients, as shown by logistic regression analysis after adjusting for gender. In HBeAg‐negative patients, REACH‐B score significantly predicted the treatment eligibility (adjusted OR: 1.783, 95% CI: 1.607–1.979, P < 0.001). Discriminatory ability of REACH‐B score to classify eligibility was poor for HBeAg‐positive patients ≥40 years [area under receiver operating characteristic (AUC): 0.664, 95% CI: 0.533–0.795], but good/excellent for HBeAg‐positive patients <40 years (AUC: 0.903; 95% CI: 0.841–0.964), HBeAg‐negative patients ≥45 years (AUC: 0.883; 95% CI: 0.848–0.917) and HBeAg‐negative patients <45 years (AUC: 0.907; 95% CI: 0.874–0.940). Conclusion The discriminatory performance of the REACH‐B scoring system in classifying anti‐viral treatment eligibility based on the 2012 APASL guideline was good/excellent, except for ≥40 years old HBeAg‐positive patients.