Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

Seung Up Kim, Yeon Seok Seo, Han Ah Lee, Mi Na Kim, Eun Hwa Kim, Ha Yan Kim, Yu Rim Lee, Hye Won Lee, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han, Seong Gyu Hwang, Kyu Sung Rim, Soon-Ho Um, Won Young Tak, Young Oh Kweon, Beom Kyung Kim, Soo Young Park

Research output: Contribution to journalArticle

Abstract

Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P < .05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P < .001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Chronic Hepatitis B
Virus Diseases
Hepatitis B virus
Antiviral Agents
Hepatocellular Carcinoma
Tenofovir
Therapeutics
Republic of Korea
Fibrosis
Teaching Hospitals
Area Under Curve
Genotype
Research Personnel

Keywords

  • CAMD Score
  • Hepatitis B Virus
  • Hepatocellular Carcinoma
  • Model
  • Prediction
  • Validation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy. / Kim, Seung Up; Seo, Yeon Seok; Lee, Han Ah; Kim, Mi Na; Kim, Eun Hwa; Kim, Ha Yan; Lee, Yu Rim; Lee, Hye Won; Park, Jun Yong; Kim, Do Young; Ahn, Sang Hoon; Han, Kwang Hyub; Hwang, Seong Gyu; Rim, Kyu Sung; Um, Soon-Ho; Tak, Won Young; Kweon, Young Oh; Kim, Beom Kyung; Park, Soo Young.

In: Clinical Gastroenterology and Hepatology, 01.01.2019.

Research output: Contribution to journalArticle

Kim, SU, Seo, YS, Lee, HA, Kim, MN, Kim, EH, Kim, HY, Lee, YR, Lee, HW, Park, JY, Kim, DY, Ahn, SH, Han, KH, Hwang, SG, Rim, KS, Um, S-H, Tak, WY, Kweon, YO, Kim, BK & Park, SY 2019, 'Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2019.06.028
Kim, Seung Up ; Seo, Yeon Seok ; Lee, Han Ah ; Kim, Mi Na ; Kim, Eun Hwa ; Kim, Ha Yan ; Lee, Yu Rim ; Lee, Hye Won ; Park, Jun Yong ; Kim, Do Young ; Ahn, Sang Hoon ; Han, Kwang Hyub ; Hwang, Seong Gyu ; Rim, Kyu Sung ; Um, Soon-Ho ; Tak, Won Young ; Kweon, Young Oh ; Kim, Beom Kyung ; Park, Soo Young. / Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy. In: Clinical Gastroenterology and Hepatology. 2019.
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abstract = "Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6{\%} male; 32.4{\%} with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9{\%} of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P < .05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3{\%} in patients with low CAMD scores (<8), 8.0{\%} in patients with intermediate CAMD scores (8–13), and 24.3{\%} in patients with high CAMD scores (>13) (P < .001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.",
keywords = "CAMD Score, Hepatitis B Virus, Hepatocellular Carcinoma, Model, Prediction, Validation",
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TY - JOUR

T1 - Validation of the CAMD Score in Patients With Chronic Hepatitis B Virus Infection Receiving Antiviral Therapy

AU - Kim, Seung Up

AU - Seo, Yeon Seok

AU - Lee, Han Ah

AU - Kim, Mi Na

AU - Kim, Eun Hwa

AU - Kim, Ha Yan

AU - Lee, Yu Rim

AU - Lee, Hye Won

AU - Park, Jun Yong

AU - Kim, Do Young

AU - Ahn, Sang Hoon

AU - Han, Kwang Hyub

AU - Hwang, Seong Gyu

AU - Rim, Kyu Sung

AU - Um, Soon-Ho

AU - Tak, Won Young

AU - Kweon, Young Oh

AU - Kim, Beom Kyung

AU - Park, Soo Young

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P < .05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P < .001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

AB - Background & Aims: Researchers previously developed a scoring system to determine the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection, based on the presence of cirrhosis, patient age, male sex, and diabetes (called the CAMD scoring system). We validated the CAMD scoring system and compared its performance with that of other risk assessment models in an independent cohort. Methods: We followed up 3277 patients with chronic HBV infection (mean age, 48.7 y; 62.6% male; 32.4% with cirrhosis) who were treated with entecavir (n = 1725) or tenofovir (n = 1552) as the first-line antiviral agent in 4 academic teaching hospitals in the Republic of Korea. The primary outcome was development of HCC. We evaluated the ability of the CAMD, PAGE-B, and mPAGE-B scoring systems to identify patients who would develop HCC using integrated area under the curve (iAUC) analysis. Results: Over a median follow-up period of 58.2 months, 8.9% of the patients developed HCC. Patients who developed HCC were older, more likely to be male, and had higher proportions of cirrhosis and diabetes than patients who did not develop HCC (all P < .05). CAMD scores identified patients who developed HCC with an iAUC of 0.790, mPAGE-B scores with an iAUC of 0.769, and PAGE-B scores with an iAUC of 0.760. The 5-year cumulative risks of HCC were 1.3% in patients with low CAMD scores (<8), 8.0% in patients with intermediate CAMD scores (8–13), and 24.3% in patients with high CAMD scores (>13) (P < .001 for comparison of low- vs intermediate-score groups and between intermediate- vs high-score groups). The predicted and observed probabilities of HCC had excellent agreement. Conclusions: We validated the CAMD scoring system in determining the risk of HCC in patients with chronic HBV treatment receiving entecavir or tenofovir treatment. Validation was performed in a cohort of patients in the Republic of Korea, where most patients have genotype C2 HBV infection.

KW - CAMD Score

KW - Hepatitis B Virus

KW - Hepatocellular Carcinoma

KW - Model

KW - Prediction

KW - Validation

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