Validação do escore Page-B como prognóstico de evoluçãopara carcinoma hepatocelular (CHC) na hepatite b crônica, na população brasileira

Abstract

Introduction – Hepatitis B virus (HBV) infection is a global public health problem. In view of this, the World Health Organization (WHO) recommends the use of orally administered and licensed drugs for the treatment, such as tenofovir (TDF) or entecavir (ETV). These drugs hinder the formation of new copies of the virus and are potent antivirals, as they have a high genetic barrier. Therefore, they constitute an important preventive therapy, as a lower viral load of the hepatitis B virus (HBV) can reduce the risk of developing liver cirrhosis (HC) and hepatocellular carcinoma (HCC), the latter being one of the most serious consequences of evolution of this infection. Considering such prevention, risk scores have been developed and validated to predict the development of HCC. Among the various evaluation tools available in the literature, the PAGE-B score seems to be the most promising, as it presents a high level of agreement, using few variables available in any medical records: platelets, age and gender. Despite this, this evaluator has not been validated in multiethnic populations; only in Caucasians and Asians. Objective – Validation of the PAGE-B risk score in the development of HCC in a multiethnic population of Brazilian patients with HBV. Method – This is a cohort, historical, retrospective, descriptive and analytical study. The study population consisted of patients with chronic HBV who were being treated with antiviral drugs. The sample consisted of 659 individuals monitored at a reference center in the states of Bahia and Rondônia, for a minimum period of three years, undergoing antiviral treatment with nucleotides (DNA and RNA) analogues. The calculation of the risk score of the PAGE-B score was used for the analysis of the described variables: sex, age and platelet count. According to the score found for predicting HCC, the risk was classified as low, moderate and high. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) program. The cumulative probabilities of occurrence of HCC in individuals were estimated by the Kaplan-Meier method, compared with the Log-rank test. The Cox regression proportional hazard model was used to estimate the effect of several variables on the risk of occurrence of HCC. Results – The mean PAGE-B score was 12.77±5.631. According to the PAGE-B score, 206 (31.2%), 287 (43.5%) and 166 (25.3%) patients were at low, moderate and high risk of developing HCC, respectively. During the treatment and follow-up period, 31 (4.7%) patients developed HCC. These patients were predominantly male, mean age 57.4 ± 12.6, and had lower platelet levels. In the stages of fibrosis, the following data were obtained: (F0-F1) 355 (53.86%), (F2) 135 (20.48%), (F3) 59 (8.95%) and (F4) 110 ( 16.69%). Conclusion – The PAGE-B score offered 80% sensitivity, 55% specificity, 8% PPV, and 98% NPV for predicting HCC in the validation datasets. Based on the aforementioned results, it was possible to validate the PAGE-B score in Brazil, which can be a tool for predicting HCC.