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A simple AGED score for risk classification of primary liver cancer: development and validation with long-term prospective HBsAg-positive cohorts in Qidong, China
  1. Chunsun Fan1,
  2. Mengge Li1,
  3. Yu Gan1,
  4. Taoyang Chen2,
  5. Yan Sun2,
  6. Jianhua Lu2,
  7. Jinbing Wang2,
  8. Yan Jin1,
  9. Jianquan Lu2,
  10. Gengsun Qian1,
  11. Jianren Gu1,
  12. Jianguo Chen2,
  13. Hong Tu1
  1. 1State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  2. 2Department of Etiology, Qidong People’s Hospital/Qidong Liver Cancer Institute, Qidong, China
  1. Correspondence to Professor Jianguo Chen, Department of Etiology, Qidong Liver Cancer Institute, Qidong People’s Hospital, Qidong 226200, China; chenjg{at}ntu.edu.cn and Professor Hong Tu, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200032, China; tuhong{at}shsci.org

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We read with great interest the recent publication by Kim et al1 showing that patients with untreated immune tolerant (IT) chronic hepatitis B with normal alanine aminotransferase (ALT) levels had significantly higher risks of hepatocellular carcinoma (HCC) and death/transplantation than treated immune active (IA) patients who had elevated ALT levels. These results indicate that ALT is not a sensitive surrogate marker for liver cell damage, and the IT phase of HBV infection cannot be considered fully benign.2 Chu and Liaw3 have challenged this view because they speculated that the IT group in that study might include IA patients who were in remission state after experiencing unrecognised minimal ALT elevations. Apparently, the highly dynamic nature of ALT perturbation makes it inadequate to act as a predictor for HCC.

We have developed and validated an easy-to-use scoring system for primary liver cancer (PLC) risk prediction. The development data set was set up in 1996 based on a community-based prospective cohort (qidong hepatitis B infection cohort (QBC)) established in Qidong, China.4 It contained …

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