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The Chinese University of Hong Kong made public a set of scores on June 13 to predict risks of liver cancer in chronic hepatitis B patients who are receiving antiviral therapy.
Chronic hepatitis B virus (HBV) infection is the most common cause of liver cirrhosis and hepatocellular carcinoma (HCC), affecting 8% of the adult population in Hong Kong. In 2010, the university introduced the CUHK-HCC score, a simple index developed primarily for family doctors to assess the cancer risk of patients with chronic hepatitis B based on their age, albumin, bilirubin, viral load and cirrhosis. The score classifies patients into high or low HCC risk group, and predicted their risk of developing HCC in the coming 5 years without taking antiviral therapy. Its performance among patients undergoing antiviral therapy remained untested.
A longitudinal study recently conducted by Henry Chen Lik Yuen, director of Center for Liver Heath of CUHK, and his team has further supported the use of CUHK-HCC score as an effective cancer risk predictor for patients with chronic hepatitis B receiving antiviral therapy, which will have great implication on clinical management and patient education.
From 2005 to 2012, Chen and his team conducted a study to evaluate the CUHK-HCC scores of 1,531 entecavir-treated patients with either active hepatitis or liver cirrhosis. Based on the scores, 47% and 53% of the patients were classified as low and high risk group respectively. In 5 years, only 0.4% of the patients in the low risk group developed HCC, compared to 8.1% in the high risk group. This indicates that patients in the low risk group essentially have their cancer risk eliminated with antiviral therapy while patients in the high risk group are still at risk of HCC after receiving antiviral therapy. It also reaffirms the effectiveness of using the score in predicting cancer risk of patients.
"The score will help directing resources of cancer screening toward high risk patients and substantially minimizing the waiting time for ultrasound cancer screening by approximately 50%," said Chen.
According to the latest international guidelines, patients with active hepatitis or liver cirrhosis should receive antiviral therapy because they are at risk of disease progression and complications. Antiviral drugs are reimbursable from the Hospital Authority Drug Formulary. However, according to a recent report by CUHK, 4.3% of the treated patients would further develop HCC in 5 years even after receiving antiviral treatment.
CUHK's research team recommended that patients in the high risk category should keep an eye on their score and perform regular cancer screening even they are already on antiviral medication, while patients with low cancer risk should be monitored with the prediction score once a year.
