Risk assessment for hepatocellular carcinoma in chronic hepatitis B: scores and surveillance

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death (1). Chronic infection with hepatitis B virus (HBV) is a major risk factor for HCC, accounting for more than one half of cases worldwide (2). Early detection of HCC in populations with chronic HBV infection through surveillance methods is critically important in providing definitive treatment for HCC and has a major impact on patient outcomes (3), including a survival benefit as demonstrated in one prospective randomised controlled trial (4). Efforts to identify populations and individuals with HBV infection who are at high risk may contribute to the development of surveillance strategies with the greatest impact on patient outcomes; however, the implementation of an individualised approach to surveillance can be challenging. This Perspective aims to explore risk factors associated with HCC in patients with chronic HBV infection, recent data on developing scoring systems to assess risk, and how these may impact surveillance strategies.