Risk Scores for Hepatocellular Carcinoma in Chronic Hepatitis B: A Promise for Precision Medicine.

Abstract

In the past 10 years, there have been over a dozen risk scores to predict the occurrence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Many of the scores were derived in untreated CHB patients, while others were based on patients receiving antiviral therapy. In review of a total of 17 prediction scores, the variables included in these scores may be categorized into three groups: (1) liver fibrosis and cirrhosis, (2) hepatitis activities, and (3) host factors including comorbid conditions. HCC scores in untreated patients tended to include variables from all three categories, whereas of those derived in patients on therapy, few included variables representing hepatitis activities. Some variables which are well accepted as significant risk factors for HCC, such as family history, are not included in the majority of the scores. While the effects on HCC development of variables that represent hepatitic and inflammatory activities are relatively easily controlled by antiviral therapy, impact of fibrosis/cirrhosis as well as host and comorbidity factors are more difficult to modify. More work is needed for precision scores that comprehensively consider all of the relevant variables and provide individualized prediction which then may be applied to broad CHB populations. In the meantime, the existing scores are helpful for the clinician to counsel their patients of their risk of HCC, to determine candidacy for surveillance and to strategize to mitigate the risk of HCC by intervening in modifiable factors such as controlling viral/hepatitic activities and optimizing medical management of comorbidity.