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Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection?
Vincent Wai-Sun Wong1, Harry L A Janssen2
1Department 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.
Insights
Predicting hepatocellular carcinoma (HCC) risk in chronic hepatitis B patients is crucial. Established risk scores effectively exclude HCC development, aiding treatment and surveillance decisions.
Area of Science:
- Hepatology
- Oncology
- Viral Hepatitis Research
Background:
- Chronic hepatitis B is a primary driver of hepatocellular carcinoma (HCC) globally.
- Accurate HCC risk prediction is essential for guiding antiviral therapy and surveillance strategies.
- Existing HCC risk scores, primarily developed in Asian populations, utilize factors like cirrhosis, age, sex, and viral load.
Purpose of the Study:
- To evaluate the utility of existing HCC risk scores in predicting HCC development.
- To compare the applicability of different HCC risk scores in various clinical settings.
- To identify potential improvements for HCC risk prediction in chronic hepatitis B patients.
Main Methods:
- Review and analysis of validated HCC risk scores derived from Asian cohorts.
- Comparison of scores like REACH-B (community, non-cirrhotic) and GAG-HCC/CU-HCC (hospital, including cirrhosis).
- Consideration of limitations in cirrhosis diagnosis and potential role of non-invasive fibrosis tests.
Main Results:
- Several HCC risk scores demonstrate high negative predictive values (>95%) for excluding HCC development over 3-10 years.
- REACH-B is suitable for primary care in non-cirrhotic patients.
- GAG-HCC and CU-HCC are more suited for specialist settings but rely on potentially inaccurate cirrhosis assessments.
Conclusions:
- HCC risk scores are valuable tools for managing chronic hepatitis B, particularly in excluding future HCC development.
- Refinement of risk prediction may be achieved through incorporating non-invasive liver fibrosis assessments.
- Further research is needed to validate these scores in patients on antiviral therapy and in diverse ethnic groups.
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.
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