Risk stratification of primary liver cancer

Table 1 Identification and stratification patients with high risk for liver cancer

Estimated annual incidence of HCC (%)	Distinguishing feature	Risk stratification model of liver cancer
Low risk of liver cancer (< 1)	(1) HBV infected patients in immune tolerance period; (2) HBV or HCV related chronic hepatitis with SVR acquired by antiviral therapy; and (3) ALT, normal PLCtelet, non viral liver disease	HBsAg positive, REACH-B score ≥ 5 (no antiviral treatment), or PAGE-B score ≤ 9
Moderate risk of liver cancer (1-3)	(1) HBV or HCV related chronic hepatitis of LLV without antiviral treatment or after antiviral treatment, aged < 40 yr; HBV or HCV related cirrhosis with SVR obtained by antiviral therapy; and (2) non viral cirrhosis with normal ALT or chronic non viral hepatitis with abnormal ALT	(1) HBsAg positive, REACH-B score 6-11 (no antiviral treatment) or PAGE-B score 10-17; and (2) THRI score of cirrhotic patients ≤ 240
High risk of liver cancer (> 3 and < 6)	(1) HBV or HCV related cirrhosis of LLV without or after antiviral treatment; (2) non-viral cirrhosis patients with diabetes or family history of liver cancer with first-degree relatives (B1); and (3) men, age > 40 yr old; women, age > 50 yr; No antiviral therapy for HBV/HCV related chronic hepatitis	(1) HBsAg positive, REACH-B score > 12 (no antiviral treatment) or PAGE-B score ≤ 18; and (2) THRI score of cirrhotic patients > 240
Extremely high risk for liver cancer (> 6)	(1) Hepatic nodule (1-2 cm) in abdominal US examination or LGDN and HGDN in pathology; (2) HBV and HCV related cirrhotic nodules (< 1 cm); and (3) synergistic risk factors such as no antiviral treatment, HBV or HCV related liver cirrhosis with diabetes or family history of liver cancer in first-degree relatives after treatment	_

ALT: Alanine aminotransferase; HCC: Hepatocellular carcinoma; SVR: Sustained virological response; THRI: Toronto hepatocellular carcinoma risk index.