Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Abstract

Chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC) is a major health problem in Asian-Pacific regions. Antiviral therapy reduces, but does not completely prevent, HCC development. Thus, there is a need for accurate risk prediction to assist prognostication and decisions on the need for antiviral therapy and HCC surveillance. A few risk scores have been developed to predict the occurrence of HCC in CHB patients. Initially, the scores were derived from untreated CHB patients. With the development and extensive clinical application of nucleos(t)ide analog(s) (NA), the number of risk scores based on treated CHB patients has increased gradually. The components included in risk scores may be categorized into host factors and hepatitis B virus factors. Hepatitis activities, hepatitis B virus factors, and even liver fibrosis or cirrhosis are relatively controlled by antiviral therapy. Therefore, variables that are more dynamic during antiviral therapy have since been included in risk scores. However, host factors are more difficult to modify. Most existing scores derived from Asian populations have been confirmed to be accurate in predicting HCC development in CHB patients from Asia, while these scores have not offered excellent predictability in Caucasian patients. These findings support that more relevant variables should be considered to provide individualized predictions that are easily applied to CHB patients of different ethnicities. CHB patients should receive different intensities of HCC surveillance according to their risk category.

Keywords: Antiviral agents, Hepatitis B virus, Hepatocellular carcinoma, Liver cirrhosis, Risk factors, Proportional hazards models

Core Tip: Risk scores are useful in estimating hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) patients. While antiviral therapy does not eliminate the risk of hepatitis B virus (HBV)-related HCC, it modifies the natural disease course to reduce the HCC risk. CU-HCC (Chinese University-HCC), GAG-HCC (guide with age, gender, HBV DNA, core promoter mutations and cirrhosis), and REACH-B (risk estimation for HCC in CHB) scores derived from Asian CHB patients were also accurate in treated patients. The PAGE-B (platelet, age, and gender-hepatitis B) score has persistently high predictability for treated Caucasian and Asian patients with different HCC risk profiles.