In The American journal of gastroenterology
INTRODUCTION : Tenofovir disoproxil fumarate (TDF) is reportedly superior or at least comparable to entecavir (ETV) for the prevention of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients; however, it has distinct long-term renal and bone toxicities. This study aimed to develop and validate a machine learning model (designated as PLAN-S) to predict an individualized risk of HCC during ETV or TDF therapy.
METHODS : This multinational study included 13,970 CHB patients. The derivation (n=6,790), Korean validation (n=4,543), and Hong Kong-Taiwan validation cohorts (n=2,637) were established. Patients were classified as the TDF-superior group when a PLAN-S-predicted HCC risk under ETV treatment is greater than under TDF treatment, and the others were defined as the TDF-nonsuperior group.
RESULTS : The PLAN-S model was derived using eight variables and generated a c-index between 0.67 and 0.78 for each cohort. The TDF-superior group included a higher proportion of male and cirrhotic patients than the TDF-nonsuperior group. In the derivation, Korean validation, and Hong Kong-Taiwan validation cohorts, 65.3%, 63.5%, and 76.4% of patients were classified as the TDF-superior group, respectively. In the TDF-superior group of each cohort, TDF was associated with a significantly lower risk of HCC than ETV (hazard ratio=0.60-0.73, all P<0.05). In the TDF-nonsuperior group, however, there was no significant difference between the two drugs (hazard ratio=1.16-1.29, all P>0.1).
DISCUSSION : Considering the individual HCC risk predicted by PLAN-S and the potential TDF-related toxicities, TDF and ETV treatment may be recommended for the TDF-superior and TDF-nonsuperior groups, respectively.
Hur Moon Haeng, Park Min Kyung, Cheuk-Fung Yip Terry, Chen Chien-Hung, Lee Hyung-Chul, Choi Won-Mook, Kim Seung Up, Lim Young-Suk, Park Soo Young, Lai-Hung Wong Grace, Sinn Dong Hyun, Jin Young-Joo, Kim Sung Eun, Peng Cheng-Yuan, Shin Hyun Phil, Chen Chi-Yi, Kim Hwi Young, Lee Han Ah, Seo Yeon Seok, Jun Dae Won, Yoon Eileen L, Sohn Joo Hyun, Ahn Sang Bong, Shim Jae-Jun, Jeong Soung Won, Cho Yong Kyun, Kim Hyoung Su, Jang Myoung-Jin, Kim Yoon Jun, Yoon Jung-Hwan, Lee Jeong-Hoon
2023-Mar-07
