Journal of gastroenterology and hepatology · 2026
The Clinical Utility of Adding Laminin Gamma 2 Monomer to the PAGE-B Score for Hepatocellular Carcinoma Surveillance in Chronic Hepatitis B.
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Huang Chung-Feng, Liang Po-Cheng, Huang Chao-Kuan, Stec Michael, Anderson Mark, Cloherty Gavin, Tsai Pei-Chien, Lin Tzu-Chun, Ko Yu-Min, Tsai Yi-Shan, Chen Kuan-Yu, Lin Ching-Chih, Jang Tyng-Yuan, Wang Chih-Wen, Wei Yu-Ju, Lin Yi-Hung, Hsieh Ming-Yen, Lin Zu-Yau, Yeh Ming-Lun, Huang Jee-Fu, Dai Chia-Yen, Chuang Wan-Long, Yu Ming-Lung
Аннотация
BACKGROUND AND AIMS: A residual risk of hepatocellular carcinoma (HCC) persists despite the use of nucleos(t)ide analogs (NA) in chronic hepatitis B (CHB) patients. We aimed to assess the utility of baseline serum laminin gamma 2 monomer (LG2m) by integrating PAGE-B score to predict HCC.
METHODS: NA-treated CHB patients whose baseline serum LG2m, alpha-fetoprotein (AFP) and PAGE-B score were measured. We evaluated the predictive value of LG2m in subgroups stratified by cirrhosis status and PAGE-B score and proposed a HCC surveillance algorithm.
RESULTS: HCC developed in 56 of 1016 patients over a follow-up of 3651 person-years (annual incidence: 1.53%). None of the low PAGE-B patients developed HCC over 5 years. LG2m did not significantly stratify risk in high PAGE-B patients. Conversely, LG2m was significantly predictive of HCC in nonhigh PAGE-B patients (5-year incidence: 5.5% vs. 1.0% for high vs. low LG2m, p = 0.004). Integrating LG2m, AFP, and high PAGE-B achieved a sensitivity of 98.2% for HCC detection. Among patients with a nonhigh PAGE-B score, elevated LG2m was associated with a higher risk of HCC (adjusted HR, 4.40; 95% CI, 1.26-15.44), whereas AFP did not significantly stratify HCC risk in a separate analysis. Intermediate PAGE-B patients with high LG2m should receive closer HCC surveillance (annual incidence: 1.4%) as with high PAGE-B patients did (annual incidence: 1.9%).
CONCLUSION: Serum LG2m level was predictive of HCC specifically among patients with intermediate PAGE-B score. Integration of LG2m into a PAGE-B-oriented algorithm provides a biomarker-driven tool for individualized surveillance, which is vital for improving early-stage HCC detection.
METHODS: NA-treated CHB patients whose baseline serum LG2m, alpha-fetoprotein (AFP) and PAGE-B score were measured. We evaluated the predictive value of LG2m in subgroups stratified by cirrhosis status and PAGE-B score and proposed a HCC surveillance algorithm.
RESULTS: HCC developed in 56 of 1016 patients over a follow-up of 3651 person-years (annual incidence: 1.53%). None of the low PAGE-B patients developed HCC over 5 years. LG2m did not significantly stratify risk in high PAGE-B patients. Conversely, LG2m was significantly predictive of HCC in nonhigh PAGE-B patients (5-year incidence: 5.5% vs. 1.0% for high vs. low LG2m, p = 0.004). Integrating LG2m, AFP, and high PAGE-B achieved a sensitivity of 98.2% for HCC detection. Among patients with a nonhigh PAGE-B score, elevated LG2m was associated with a higher risk of HCC (adjusted HR, 4.40; 95% CI, 1.26-15.44), whereas AFP did not significantly stratify HCC risk in a separate analysis. Intermediate PAGE-B patients with high LG2m should receive closer HCC surveillance (annual incidence: 1.4%) as with high PAGE-B patients did (annual incidence: 1.9%).
CONCLUSION: Serum LG2m level was predictive of HCC specifically among patients with intermediate PAGE-B score. Integration of LG2m into a PAGE-B-oriented algorithm provides a biomarker-driven tool for individualized surveillance, which is vital for improving early-stage HCC detection.