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We read with great interest the recent paper by Abu-Amara et al 1 showing that hepatocellular carcinoma (HCC) risk scores derived from Asian cohorts with chronic hepatitis B (CHB) were applicable to a heterogeneous North American patient population as well. They reported that the scoring systems were especially accurate in identifying low-risk patients and as such it is reasonable to use them to guide HCC surveillance recommendations. Out of the five risk scores evaluated, the Chinese University (CU)-HCC and Guide with Age, Gender, HBV DNA, Core promoter mutations and Cirrhosis (GAG-HCC) performed the best.2 ,3 However, HBV DNA titres are needed in both scores and additionally, core mutation determination is needed for even better prediction in the GAG-HCC. Liu et al 4 showed that HBsAg titre is useful in stratifying HCC risk in non-viraemic patients and a recent risk score published by Lin et al 5 included HBsAg titre. These are costly tests that are not universally available.
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