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World J Gastroenterol. May 28, 2014; 20(20): 6244-6251
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6244
Risk calculators for hepatocellular carcinoma in patients affected with chronic hepatitis B in Asia
Hwai-I Yang, Mei-Hsuan Lee, Jessica Liu, Chien-Jen Chen
Hwai-I Yang, Jessica Liu, Chien-Jen Chen, Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
Hwai-I Yang, Graduate Institute of Clinical Medical Science, China Medical University, Taichung 401, Taiwan
Hwai-I Yang, Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung 401, Taiwan
Mei-Hsuan Lee, Institute of Clinical Medicine, National Yang-Ming University, Taipei 115, Taiwan
Chien-Jen Chen, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 115, Taiwan
Author contributions: Yang HI contributed to the literature search and review, manuscript drafting and final revision of the article; Lee MH, Liu J and Chen CJ contributed to the final revision of the article.
Supported by The Department of Health, Executive Yuan, Taipei, Taiwan, Bristol-Myers Squibb Co., United States; Academia Sinica, Taipei, Taiwan; the National Science Council No. NSC101-2314-B-039-029-MY3, Taipei, Taiwan; and the National Health Research Institutes (NHRI-EX98-9806PI), Chunan, Taiwan
Correspondence to: Hwai-I Yang, PhD, Genomics Research Center, Academia Sinica, 128 Academia Road Section 2, Taipei 115, Taiwan.
Telephone: +886-2-27871308 Fax: +886-2-27898811
Received: October 2, 2013
Revised: December 30, 2013
Accepted: January 20, 2014
Published online: May 28, 2014

Risk calculators are widely used in many clinical fields, and integrate several important risk factors through the conversion of a risk function into a single measure of risk. Several studies have been carried out to create risk calculators for the prediction of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). Most of them were hospital-based, with limited sample sizes and insufficient external validation. These study groups collaborated to establish the REACH-B risk score, which incorporated five clinical variables to predict HCC risk. This risk score was then validated in international clinical cohorts. Evidence suggests that quantitative serum HBsAg level provides additional predictability of HCC, especially in patients with low levels of hepatitis B virus DNA. This novel marker was incorporated into a risk calculator and was internally validated. This tool will hopefully be externally validated in the near future. Risk calculators can be used to support clinical practice, and to establish preventive measures; several “off-label” extension usages have also been implemented. Albeit beneficial, several precautions and discussions should be noted in using the risk calculators. The future development of risk calculators for CHB patients can be extended by applying them to additional CHB-related outcomes, and by incorporating emerging risk parameters.

Keywords: Chronic hepatitis B, Hepatocellular carcinoma, Risk calculator, Hepatitis B virus

Core tip: The risk calculator is a useful tool in many fields of medicine, including hepatology. This paper reviews the history of the development and validation of risk calculators of hepatocellular carcinoma (HCC) for patients with chronic hepatitis B (CHB). The rationale for using HCC risk calculators is first given, followed by a description of the course and pathway towards deriving HCC risk estimation tools for treatment-free CHB patients. Examples of the application of HCC risk prediction tools in clinical and public health settings is also shown. The paper also discusses several issues raised by the application of HCC risk scores.