Mian I, Subhaharan D, Haig A, Cox R, Masood T, Braund A, Funakoshi N. Comparing validated hepatocellular carcinoma risk scores for chronic hepatitis B against current Australian surveillance guidelines. World J Hepatol 2026; 18(6): 117996 [DOI: 10.4254/wjh.117996]
Corresponding Author of This Article
Ibrahim Mian, MBBS, Department of Digestive Health, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. ibrahim.mian@health.qld.gov.au
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Mian I, Subhaharan D, Haig A, Cox R, Masood T, Braund A, Funakoshi N. Comparing validated hepatocellular carcinoma risk scores for chronic hepatitis B against current Australian surveillance guidelines. World J Hepatol 2026; 18(6): 117996 [DOI: 10.4254/wjh.117996]
World J Hepatol. Jun 27, 2026; 18(6): 117996 Published online Jun 27, 2026. doi: 10.4254/wjh.117996
Comparing validated hepatocellular carcinoma risk scores for chronic hepatitis B against current Australian surveillance guidelines
Ibrahim Mian, Deloshaan Subhaharan, Adam Haig, Rupert Cox, Tariq Masood, Alicia Braund, Natalie Funakoshi
Ibrahim Mian, Deloshaan Subhaharan, Adam Haig, Rupert Cox, Tariq Masood, Alicia Braund, Natalie Funakoshi, Department of Digestive Health, Gold Coast University Hospital, Gold Coast 4215, Queensland, Australia
Author contributions: Mian I, Subhaharan D, Haig A, and Funakoshi N were involved with the conception, design of the study, and were involved in the acquisition, analysis, and interpretation of data; Mian I wrote the manuscript. Mian I, Subhaharan D, Haig A, Cox R, Masood T, Braund A, and Funakoshi N critically reviewed and provided final approval of the manuscript.
AI contribution statement: ChatGPT was used in a limited capacity to assist with editing of language when drafting response to reviewer comments. No portion of the main text of manuscript was AI-generated. No AI tool was used for language polishing, translation, data analysis, or writing assistance of the manuscript. AI was not used in design of the study or interpretation of the results. No images were AI generated.
Institutional review board statement: The study was reviewed and approved by the Gold Coast Hospital and Health Service Human Research Ethics Committee, No. EX/2022/QGC/91272.
Informed consent statement: The requirement for informed consent was waived due to the retrospective nature of the study and use of de-identified data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Corresponding author: Ibrahim Mian, MBBS, Department of Digestive Health, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast 4215, Queensland, Australia. ibrahim.mian@health.qld.gov.au
Received: January 4, 2026 Revised: February 18, 2026 Accepted: May 12, 2026 Published online: June 27, 2026 Processing time: 179 Days and 4 Hours
Abstract
BACKGROUND
Chronic hepatitis B (CHB) patients are at increased risk of developing hepatocellular carcinoma (HCC), however risk varies greatly between individuals. The Gastroenterological Society of Australia (GESA) consensus guidelines were developed to ensure patients receive appropriate surveillance; however, these guidelines do not account for other established risk factors. Various HCC risk scoring systems have been developed, including the Risk Estimation for HCC in CHB (REACH-B), modified REACH-B (mREACH-B) and Platelet Age Gender-Hepatitis B (PAGE-B) scores which have been validated in specific ethnic populations.
AIM
To evaluate differences in HCC surveillance patterns between current GESA recommendations and risk scoring tools for non-cirrhotic CHB patients.
METHODS
A prospectively collected health registry identified all patients with CHB from a regional tertiary Australian hospital in South East Queensland from 2019 to 2022. REACH-B, mREACH-B and PAGE-B scores were calculated for non-cirrhotic CHB patients. Surveillance patterns between scoring systems and current guidelines were compared.
RESULTS
A total of 314 patients were included. 35.0% (n = 110) were male, with a median age of 50.6 years. 69.7% of patients originated from Asia, 9.6% had a positive hepatitis B e-antigen status, and 37.9% were on antiviral therapy. Only 2 (0.6%) patients had progression to HCC. Using the GESA guidelines, 57% of patients qualified for HCC surveillance. However, when applying REACH-B, mREACH-B and PAGE-B scores, surveillance was recommended for 23.2%, 12.4% and 46.8% of patients respectively. This represented marked discordance between guideline-based and score-based surveillance eligibility. Notably, none of the scores identified the two patients who developed HCC as candidates for surveillance. All scores demonstrated poor discriminatory performance, with an area under the receiver operating characteristic curve of 0.53 for REACH-B, 0.55 for mREACH-B, and 0.39 for PAGE-B.
CONCLUSION
REACH-B, mREACH-B, and PAGE-B offer alternative options for risk stratification. However, this study suggests that the accuracy of these risk scores when applied to the Australian population may be limited, likely due to local virological, socio-demographic and lifestyle related factors which need to be taken into account. In heterogenous populations, these risk scores should be used cautiously and alongside individualized clinical assessment rather than as standalone decision tools.
Core Tip: Hepatocellular carcinoma (HCC) surveillance in people with chronic hepatitis B (CHB) aims to detect cancer early, however, there is a risk of over- or under-surveillance. In this Australian cohort, the validated HCC risk scores Risk Estimation for HCC in CHB, modified Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B, and Platelet Age Gender-Hepatitis B identified substantially fewer patients for surveillance compared with the current Gastroenterological Society of Australia guidelines. Importantly, these risk scores failed to identify all patients who developed HCC, highlighting the limitations of applying population-specific tools to Australia’s heterogeneous CHB population.
