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 and HBV DNA levels
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 |
2 |
HBEAg |
HBV DNA levels |
Points |
negative |
< 300 copies per mL |
0 |
negative |
300 to 9,999 copies per mL |
1 |
negative |
10,000 to 99,999 copies per mL |
3 |
negative |
100,000 to 999,999 copies/mL |
4 |
negative |
>= 10^6 copies per mL |
5 |
positive |
|
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 |
0.010% |
0.03% |
1 |
0.025% |
0.05% |
2 |
0.030% |
0.08% |
3 |
0.049% |
0.12% |
4 |
0.080% |
0.21% |
5 |
0.130% |
0.4% |
6 |
0.210% |
0.66% |
7 |
0.40% |
1% |
8 |
0.70% |
1.8% |
9 |
1% |
3% |
10 |
1.7% |
5% |
11 |
3% |
8% |
12 |
5% |
13% |
13 |
8% |
21% |
14 |
12% |
33% |
15 |
20% |
50% |
16 |
31% |
63% |
17 |
50% |
90% |
18 |
80% |
100% |
19 |
90% |
100% |
20 |
100% |
100% |
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,