title: Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection?
abstract: Chronic hepatitis B is one of the leading causes of hepatocellular carcinoma (HCC) worldwide. Accurate prediction of HCC risk is important for decisions on antiviral therapy and HCC surveillance. In the last few years, a number of Asian groups have derived and validated several HCC risk scores based on well-known risk factors such as cirrhosis, age, male sex and high viral load. Overall, these scores have high negative predictive values of over 95% in excluding HCC development in 3 to 10 years. The REACH-B score was derived from a community cohort of non-cirrhotic patients and is better applied in the primary care setting. In contrast, the GAG-HCC and CU-HCC scores were derived from hospital cohorts and include cirrhosis as a major integral component. While the latter scores may be more applicable to patients at specialist clinics, the diagnosis of cirrhosis based on routine imaging and clinical parameters can be inaccurate. To this end, recent developments in non-invasive tests of liver fibrosis may further refine the risk prediction. The application of HCC risk scores in patients on antiviral therapy and in other ethnic groups should be evaluated in future studies.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Toronto Center for Liver Disease, Toronto Western and General Hospital, University Health Network, Toronto, Canada; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: harry.janssen@uhn.ca.
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D004279:DNA, Viral / Q000032:analysis; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology*; D012306:Risk
chemical_list: D004279:DNA, Viral
keywords: Cirrhosis; HBV DNA; Hepatitis B virus; Hepatocellular carcinoma; Transient elastography