Page 491 - Read Online

Yilmaz et al. Hepatoma Res 2018;4:46 I http://dx.doi.org/10.20517/2394-5079.2018.49 Page 5 of 10

There is also a risk stratification model for non-cirrhotic HCCs. PAGE-B (platelet, age, gender, hepatitis B)
that is developed for HBV is recommended for non-cirrhotic HBV patients by EASL-2018 [2,24,41] .

Recommendations from guidelines are as follows.

From North America
AASLD-2017: there is no proposal for non-cirrhotic patients in the current guideline. The previous AASLD
guideline (2010), described the high-risk HBV carriers for HCC [Table 2] and the recommendation for
screening was US in every 6 months [26,27] .

CASL-2014: identical with AASLD-2010, the CASL recommends HCC screening for the following high-risk
groups by using US in every 6 months: Asian male hepatitis B carriers over the age of 40, Asian female hepa-
titis B carriers over the age of 50, hepatitis B carriers with a family history of HCC, Africans and African
[29]
Americans with hepatitis B .

From Asia
APASL-2017: recommendations for non-cirrhotic group similar to CASL. Differently, they recommend
screening in Africans older than 20 years old. The surveillance strategy is combination of US and serum
AFP, every 6 months, recommending that the cut-off value of AFP can be set at a lower value in a population
[30]
with hepatitis virus suppression or eradication .

CHINESE-2017: recommendations for non-cirrhotic-chronic liver diseases (any etiology) are AFP with ul-
[31]
trasonography in every 6 months for surveillance .
JSH-2015 and JSH-LCSG 2014: for the high- risk non-cirrhotic (patients with chronic hepatitis B, chronic
hepatitis C), they recommend an US examination along with measurement of three tumour markers (AFP/
PIVKA-II, AFP-L3) in every 6 months [Table 2] [32-34] .

From Europe
EASL-2018: categorized the non-cirrhotic HBV patients at intermediate or high risk of HCC according to
PAGE-B classes for Caucasian subjects, respectively 10-17 and ≥ 18 score points [2,41] .

To this group and non-cirrhotic F3 patients, regardless of etiology screening based on an individual, risk as-
sessment is recommended for patients in the low HCC risk class (PAGE-B score ≤ 9), who do not reach the
0.2%/year threshold for starting screening. The PAGE-B score has not yet been validated in Asia due to Cau-
[2]
casian subjects. They recommend an US examination in every 6 months .
The consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH -2016 has not specified the
[35]
screening for non-cirrhotic subjects . However, SEOM-2015 recommended screening for high-risk HBV
chronic hepatitis patients (higher viral load, viral genotype or Asian or African ancestry) and non-cirrhotic
[37]
patients with chronic hepatitis C and advanced fibrosis (F3) .

ESMO-ESDO-2012 recommendations are similar to SEOM-2015, which suggests to non-cirrhotic HBV car-
riers with high viral load (> 10.000 copy/mL) and non-cirrhotic patients with chronic hepatitis C and ad-
[36]
vanced cirrhosis .
This section was summarized in Table 2.