Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2021; 9(14): 3238-3251
Published online May 16, 2021. doi: 10.12998/wjcc.v9.i14.3238
Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients
Jiang Guo, Xue-Song Gao
Jiang Guo, Department of Interventional Oncology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Xue-Song Gao, Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Author contributions: Guo J conducted the literature search and wrote the first version of the manuscript; Gao XS conceived of the manuscript, designed the review, and revised the final version of the manuscript.
Supported by National Science and Technology Major Project of China, No. 2018ZX10715-005-003-002; and Health Development and Scientific Research in the Capital, No. 2018-1-2181.
Conflict-of-interest statement: There is no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xue-Song Gao, MD, PhD, Chief Physician, Department of General Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Chaoyang District, Beijing 100015, China. gaoxuesong@ccmu.edu.cn
Received: January 18, 2021
Peer-review started: January 18, 2021
First decision: February 9, 2021
Revised: February 11, 2021
Accepted: March 17, 2021
Article in press: March 17, 2021
Published online: May 16, 2021
Processing time: 100 Days and 20.7 Hours
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.