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Real-world risk score for hepatocellular carcinoma (RWS-HCC): a clinically practical risk predictor for HCC in chronic hepatitis B
  1. Zhongxian Poh1,
  2. Liang Shen2,
  3. Hwai-I Yang3,4,
  4. Wai-Kay Seto5,
  5. Vincent W Wong6,
  6. Clement Y Lin1,
  7. Boon-Bee George Goh1,
  8. Pik-Eu Jason Chang1,7,
  9. Henry Lik-Yuen Chan6,
  10. Man-Fung Yuen5,
  11. Chien-Jen Chen3,8,
  12. Chee-Kiat Tan1,7
  1. 1Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
  2. 2Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  3. 3Genomics Research Center, Academia Sinica, Taipei, Taiwan
  4. 4Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
  5. 5Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
  6. 6Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  7. 7Duke-NUS Medical School, Singapore, Singapore
  8. 8Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Adjunct Associate Professor Chee-Kiat Tan, Department of Gastroenterology & Hepatology, Singapore General Hospital, Academia, 20 College Road, Level 3, Singapore 169856, Singapore; tan.chee.kiat{at}

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We read with great interest the recent paper by Abu-Amara et al1 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 al4 showed that HBsAg titre is useful in stratifying HCC risk in non-viraemic patients and a recent risk score published by Lin et al5 included HBsAg titre. These are costly tests that are not universally available.

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