Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B

Voulgaris, Theodoros; Papatheodoridi, Μargarita; Lampertico, Pietro; Papatheodoridis, George V.

doi:10.1111/liv.14334

Cited by 49 publications

(68 citation statements)

References 46 publications

(360 reference statements)

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“…Because patients with active phase CHB or cirrhosis should be treated and included in the HCC surveillance program, HCC risk scores for these patients are not absolutely required. In fact, most adult patients with CHB are candidates for HCC surveillance regardless of their disease status and treatment, except subgroups of patients who achieve HBsAg seroclearance and have less than 0.2% of annual risk to develop HCC 24,43–46 . Therefore, the practical role of HCC risk scores is limited in identifying patients who may benefit from but are not indicated for treatment by current practice guidelines (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Currently, a total of 12 HCC risk scores have been developed for untreated CHB patients from East Asia (Table 2). 45 Five of these scores include LSM or parameters assessing advanced hepatic fibrosis as important predictive factors. Because the extension of current treatment indications in CHB patients without cirrhosis are being considered, the usefulness of those five risk scores may be limited for this purpose as well as for the reason of availability and affordability.…”

Section: Resultsmentioning

confidence: 99%

“…required anti-viral therapy in 10 years. 44 24,[43][44][45][46] Therefore, the practical role of HCC risk scores is limited in identifying patients who may benefit from but are not indicated for treatment by current practice guidelines (Figure 1). practice guidelines and reimbursement policies recommend using HCC risk scores in deciding treatment initiation in patients with CHB.…”

Section: Hepatic Fibrosismentioning

confidence: 99%

“…Currently, a total of 12 HCC risk scores have been developed for untreated CHB patients from East Asia ( Table 2). 45 Weighting HBV DNA levels in HCC risk scores • GAG-HCC22: 3 × log HBV DNA (cp/mL) (HBV DNA > 6 log cp/mL as a group) • CU-HCC 31 : HBV DNA (≤4/4-6/>6 log cp/mL: 0/1/4) • REACH-B 46 : HBV DNA (0-<10 4 /10 4 -<10 5 /10 5 -<10 6 /≥10 6 cp/mL: 0/3/5/4) • REACH-B II 49 Declaration of personal interests: None.…”

Section: Assessment Of Hcc Risk Scores For the Extension Of Treatmementioning

confidence: 99%

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East Asia expert opinion on treatment initiation for chronic hepatitis B

Kao¹,

Hu²,

Jia³

et al. 2020

Aliment Pharmacol Ther

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Background: Globally, chronic hepatitis B (CHB) is a major public health concern. Timely and effective management can prevent disease progression to cirrhosis and reduce the risk of hepatocellular carcinoma (HCC). Currently, there is no consensus on the clinical management of CHB in East Asia. Aim: To establish an East Asia expert opinion on treatment initiation for CHB based on alanine aminotransferase (ALT) level, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) level, cirrhosis and HCC risk scores. Methods: A meeting was held online with a panel of 10 experts from East Asia to discuss ALT, HBV DNA, cirrhosis and HCC risk scores. Indications for CHB treatment in the latest international guidelines were reviewed. Consensus was summarised to provide recommendations on the initiation of treatment for CHB. Results: Anti-viral therapy is recommended for CHB patients with (a) HBV DNA ≥ 2000 IU/mL and ALT ≥ 1× upper limit of normal (ULN); (b) HBV DNA ≥ 2000 IU/ mL, ALT < 1× ULN and ≥ F2 fibrosis and/or ≥ A2 necroinflammation occurs; (c) cirrhosis and detectable HBV DNA; or (d) HBV DNA ≥ 2000 IU/mL, ALT < 1× ULN and a family history of cirrhosis or HCC, extrahepatic manifestations or age > 40 years. Patients with cirrhosis and/or HCC should be treated regardless of ALT levels if HBV DNA level is detectable. Initiating anti-viral therapy or close monitoring at 3-month intervals is recommended for CHB patients with at least two HCC risk factors. Conclusions: These expert recommendations will contribute to a new standard of daily clinical practice in East Asia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Hepatic Fibrosismentioning

confidence: 99%

Section: Assessment Of Hcc Risk Scores For the Extension Of Treatmementioning

confidence: 99%

See 2 more Smart Citations

East Asia expert opinion on treatment initiation for chronic hepatitis B

Kao¹,

Hu²,

Jia³

et al. 2020

Aliment Pharmacol Ther

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“…Major efforts should be implanted to improve the diagnostic accuracy of the current available tools for HCC surveillance. In that regard, risk‐based strategies and periodicity could favour cost‐effectiveness 14 . In addition, major hopes are placed in AFP and other biomarkers that could surpass most of the limitations of the current imaging modalities 15,16 …”

Section: Figurementioning

confidence: 99%

Adherence and quality are key for a beneficial HCC surveillance

Fonseca

Forner

2020

Liver International

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Chronic hepatitis B virus infection and the risk of hepatocellular carcinoma by age and country of origin in people living in Sweden: A national register study

et al. 2022

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Chronic hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC), and surveillance is recommended for patients without cirrhosis when risk exceeds an incidence rate (IR) of 0.2%. Populations in Asia and sub‐Saharan Africa have been associated with HCC at younger ages, but the risk after immigration to Western countries should be investigated. The aim of this study was to study HCC by age and country of origin in people with chronic HBV infection in Sweden. Through national registers, residents with chronic HBV diagnosis (1990–2015) were identified with information on country of origin, immigration/emigration, death, coinfections, antiviral therapy, and HCC. Observation time started at HBV diagnosis, and IR and hazard ratios for HCC were calculated by sex, age, and region of origin. Among 16,410 individuals (47% women), the origin and observation time (person years) were as follows: Western Europe, 2316 (25,415); Eastern Europe, 2349 (26,237); Middle East/North Africa, 4402 (47,320); sub‐Saharan Africa, 3677 (30,565); Asia, 3537 (35,358); and other, 129 (1277). There were 232 individuals with HCC (82% in men). The IR increased with age and exceeded 0.2% for Asian men from age group 40–49 years (IR, 0.63; 95% confidence interval, 0.39–1.00), for men of other origins from age group 50–59 years, and for women aged ≥60 years originating from Eastern Europe, Asia, and Middle East/North Africa. After exclusion of patients with cirrhosis or HBV treatment, the IR still exceeded 0.2% in Asian men aged 40–49 years. This study demonstrates that HBV‐infected men of Asian origin should be recommended HCC surveillance at younger ages, but there is a need for further studies of HCC incidence in African‐born men without cirrhosis living in the Western world.

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Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B

Cited by 49 publications

References 46 publications

East Asia expert opinion on treatment initiation for chronic hepatitis B

East Asia expert opinion on treatment initiation for chronic hepatitis B

Adherence and quality are key for a beneficial HCC surveillance

Chronic hepatitis B virus infection and the risk of hepatocellular carcinoma by age and country of origin in people living in Sweden: A national register study

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