Yang et al developed a number of nomograms for predicting the risk of hepatocellular carcinoma (HCC) occurring in a patient with chronic viral hepatitis B. These can help to identify a patient who may benefit from closer monitoring over time. The authors are from National Taiwan University, Chang Gung University, Toronto General Hospital and Bristol Myers Squibb.
Patient selection: adults from 30 to 65 years of age with chronic HBV from Taiwan
Parameters:
(1) age
(2) gender
(3) family history of hepatocellular carcinoma
(4) alcohol intake (drinking alcohol at least 4 times per week for at least 1 year)
(5) serum ALT in IU/L (reference range and method not specified)
(6) HBeAg status, HBV DNA levels and HBV genotype
|
Parameter |
Finding |
Points |
|---|---|---|
|
age |
30 to 34 years |
0 |
|
|
35 to 39 years |
1 |
|
|
40 to 44 years |
2 |
|
|
45 to 49 years |
3 |
|
|
50 to 54 years |
4 |
|
|
55 to 59 years |
5 |
|
|
60 to 65 years |
6 |
|
gender |
female |
0 |
|
|
male |
2 |
|
family history of HCC |
no |
0 |
|
|
yes |
2 |
|
regular alcohol intake |
no |
0 |
|
|
yes |
2 |
|
serum ALT |
< 15 IU/L |
0 |
|
|
15 to 44 IU/L |
1 |
|
|
>= 45 IU/L |
1 |
|
HBEAg |
HBV DNA levels |
HBV Genotype |
Points |
|---|---|---|---|
|
negative |
< 300 copies per mL |
NA |
0 |
|
negative |
300 to 9,999 copies per mL |
NA |
1 |
|
negative |
10,000 to 99,999 copies per mL |
B or B+C |
3 |
|
negative |
10,000 to 99,999 copies per mL |
C |
4 |
|
negative |
100,000 to 999,999 copies/mL |
B or B+C |
3 |
|
negative |
100,000 to 999,999 copies/mL |
C |
7 |
|
negative |
>= 10^6 copies per mL |
B or B+C |
4 |
|
negative |
>= 10^6 copies per mL |
C |
7 |
|
positive |
NA |
NA |
6 |
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the greater the risk of the patient developing hepatocellular carcinoma.
|
Total Score |
5 Year Risk |
10 Year Risk |
|---|---|---|
|
0 |
0.008% |
0.024% |
|
1 |
0.013% |
0.042% |
|
2 |
0.024% |
0.073% |
|
3 |
0.042% |
0.11% |
|
4 |
0.080% |
0.20% |
|
5 |
0.120% |
0.33% |
|
6 |
0.210% |
0.60% |
|
7 |
0.40% |
1% |
|
8 |
0.61% |
1.6% |
|
9 |
1% |
3% |
|
10 |
2% |
5% |
|
11 |
3.2% |
9% |
|
12 |
5.3% |
12% |
|
13 |
9% |
21% |
|
14 |
13% |
31% |
|
15 |
21% |
50% |
|
16 |
32% |
70% |
|
17 |
52% |
83% |
|
18 |
70% |
93% |
|
19 |
90% |
100% |
|
20 |
100% |
100% |
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
