Risk prediction of hepatitis B virus-related hepatocellular carcinoma in the era of antiviral therapy

Abstract

Chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) is a major health problem in Asian-Pacific regions. Antiviral therapy reduces, but does not eliminate the risk of HCC. It would be a heavy financial burden in most low and middle economic countries if all CHB patients received antiviral therapy and HCC surveillance. Thus, there is a need for accurate risk prediction to assist prognostication, decisions on the need for antiviral therapy and HCC surveillance. A few well-established risk factors for HCC, namely advanced age, male gender, high viral load, cirrhosis etc., are the core components of three HCC risk scores: CU-HCC, GAG-HCC and REACH-B scores. These 3 scores were confirmed to be accurate in predicting HCC up to 10 years in treatment-naïve patients. Their validity and applicability have recently been demonstrated in a large cohort of entecavir treatment patients. A decrease in risk scores after antiviral therapy translates to a lower risk of HCC. These findings support the application of HCC risk scores in all CHB patients. Different levels of care and different intensities of HCC surveillance should be offered according to the risk profile of patients. Patients at risk of HCC should undergo regular HCC surveillance, even when they are receiving antiviral treatment.

Keywords: Antiviral therapy; Cirrhosis; Hepatitis B virus DNA; Hepatocellular carcinoma; Risk prediction score; Transient elastography

Core tip: CU-hepatocellular carcinoma (HCC), GAG-HCC and REACH-B scores accurately predict subsequent HCC development in both treatment-naïve patients with chronic hepatitis B and those receiving antiviral therapy. At the recommended cutoff values, baseline CU-HCC and REACH-B scores had high sensitivity, while the GAG-HCC score had high specificity in predicting HCC. Patients persistently in the low-risk category have the lowest risk of HCC; those “downgraded” in risk category have significantly lower, but a small risk of HCC compared to those in the high-risk category. Patients in the high-risk category either at baseline or after treatment should undergo HCC surveillance.