Background and Aim: It is well established that patients with chronic hepatitis B (CHB) are at increased risk of developing hepatocellular carcinoma (HCC), even without underlying cirrhosis; however, the risk varies greatly between individuals. The recently published Gastroenterological Society of Australia (GESA) consensus guidelines were developed to ensure high-risk patients are adequately surveilled with regular ultrasound and alpha-fetoprotein testing, with a focus on cost-effectiveness. These guidelines consider age, ethnicity, sex, and family history but do not account for other established risk factors for HCC development, such as ongoing hepatocellular inflammation, viral load, or hepatitis B e-antigen (HBeAg) status. As a result, various alternative risk scoring systems have been developed, including the REACH-B and PAGE-B scores, which are validated in Asian and European populations, respectively. We aimed to evaluate the differences in surveillance patterns between HCC risk scoring systems and current GESA guidelines for non-cirrhotic patients with CHB.

Methods: We conducted a retrospective cross-sectional observational study at a single tertiary center in Queensland, Australia. REACH-B and PAGE-B scores were calculated for all non-cirrhotic patients with CHB between 2019 and 2022. Cutoffs for both REACH-B and PAGE-B scores were set at nine, as these scoring systems classified any scores of nine or less as low risk. Surveillance patterns between scoring systems and current guidelines were compared.

Results: A total of 314 patients were included (35% male, 65% female). The median age was 50 years (range, 22–85 years). Of the patients, 67.9% (n = 219) originated from Asia, and 9.6% (n = 30) had a positive HBeAg status. Using the GESA guidelines, 57% of patients (n = 179) qualified for HCC surveillance. However, applying REACH-B and PAGE-B scores, surveillance was recommended for 2.9% of patients (n = 9) with a median score of 6 points (range, 0 to 11 points) and 16.9% of patients (n = 53) with a median score of 4 points (range, −4 to 17 points), respectively (Fig. 1).

Conclusion: The validated REACH-B and PAGE-B scoring systems provide alternative options for risk stratification among patients with CHB. Their application significantly alters the proportion of patients requiring HCC surveillance. This may have important implications for health care resource utilization and cost-effectiveness.