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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. 1 Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
  2. 2 Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  3. 3 Genomics Research Center, Academia Sinica, Taipei, Taiwan
  4. 4 Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
  5. 5 Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
  6. 6 Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  7. 7 Duke-NUS Medical School, Singapore, Singapore
  8. 8 Graduate 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 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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  • Contributors ZP and C-KT contributed equally to the data and to the writing of the letter. LS contributed to the statistical analyses, risk model derivation and statistical reporting. VWW, M-FY, B-BGG and P-EJC contributed to the writing of the letter. C-JC, M-FY, HL-YC, H-IY, W-KS and VWW contributed to the validation datasets and to the refinement of the letter. CYL contributed to the data.

  • Competing interests None declared.

  • Ethics approval SingHealth Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.