title: Clinical scoring system to predict hepatocellular carcinoma in chronic hepatitis B carriers.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) infection is an important etiology for hepatocellular carcinoma (HCC). We aim to develop a simple clinical score in predicting the risk of HCC among HBV carriers.
  
  
  METHODS
  We first evaluated 1,005 patients and found that the following five factors independently predicted HCC development: age, albumin, bilirubin, HBV DNA, and cirrhosis. These variables were used to construct a prediction score ranging from 0 to 44.5. The score was validated in another prospective cohort of 424 patients.
  
  
  RESULTS
  During a median follow-up of 10 years, 105 patients (10.%) in the training cohort and 45 patients (10.6%) in the validation cohort developed HCC. Cutoff values of 5 and 20 best discriminated HCC risk. By applying the cutoff value of 5, the score excluded future HCC development with high accuracy (negative predictive value = 97.8% and 97.3% in the training and validation cohorts, respectively). In the validation cohort, the 5-year HCC-free survival rates were 98.3%, 90.5%, and 78.9% in the low-, medium-, and high-risk groups, respectively. The hazard ratios for HCC in the medium- and high-risk groups were 12.8 and 14.6, respectively.
  
  
  CONCLUSIONS
  A simple prediction score constructed from routine clinical and laboratory parameters is accurate in predicting HCC development in HBV carriers. Future prospective validation is warranted.
authors.affiliation: Department of Medicine and Therapeutics and Institute of Digestive Disease, Chinese University of Hong Kong; State Key Laboratory in Oncology in South China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Stephen Lam
authors.initials: SL
authors.lastname: Chan
authors.forename: Frankie
authors.initials: F
authors.lastname: Mo
authors.forename: Tung-Ching
authors.initials: TC
authors.lastname: Chan
authors.forename: Herbert Ho-Fung
authors.initials: HH
authors.lastname: Loong
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Yanni Yan-Ni
authors.initials: YY
authors.lastname: Lui
authors.forename: Anthony Tak-Cheung
authors.initials: AT
authors.lastname: Chan
authors.forename: Joseph Jao-Yiu
authors.initials: JJ
authors.lastname: Sung
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
authors.forename: Tony Shu-Kam
authors.initials: TS
authors.lastname: Mok
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D002353:Carrier State; D018572:Disease-Free Survival; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors