Cirrhotic
SVR
Age
Gender
BMI
Race/Ethnicity
Genotype 3
Platelet Count
AST
ALT
Albumin
INR
Hemoglobin
3-year HCC risk

Hepatocellular Carcinoma (HCC) Risk calculator

  • These models were developed using data from the Veterans Affairs healthcare system in patients with hepatitis C (Ioannou J Hep 2018 (69): 1088-1098) and NAFLD/ALD-cirrhosis (Ioannou J Hep 2019 (71): 523-533)
  • The aim of this tool is to estimate the 3-year risk of HCC in patients with hepatitis C virus (HCV) infection who have undergone antiviral treatment or in patients with cirrhosis caused by alcohol-related liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD).
  • Enter the patient’s age and labs, using values obtained before the initiation of HCV treatment.
  • 3 year risk refers to the 3 year period after SVR ascertainment
  • This risk calculator should not be used in patients with a previously diagnosed HCC, prior liver transplant, or cirrhosis from other etiologies (e.g. alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis B).
  • This risk calculator has not been validated among patients without prior HCV treatment.
  • This tool is not designed for use by patients.
  • For patients with Child A or B cirrhosis or Child C cirrhosis on the transplant waiting list, it is recommended they receive screening with abdominal ultrasound with or without serum AFP every 6 months.
  • Diagnostic evaluation for HCC among patients with abnormal screening results should include either multiphasic CT or MRI.
  • Patients with confirmed HCC who wish to undergo treatment should be referred to a medical center with expertise in treating HCC and liver transplantation capabilities.

For clinicians

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. In the United States, about 90% of cases of HCC occur in patients with cirrhosis. In patients with cirrhosis, screening every 6 months with ultrasound +/- serum alpha fetoprotein (AFP) may identify HCC at an earlier stage when it is more amenable to treatment. HCC screening is currently recommended by the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) for patients with Child’s A or B cirrhosis or those listed for liver transplantation. However the risk of HCC varies greatly among patients with cirrhosis.

This risk calculator provides estimates of the 3-year risk of HCC in:

  • Patients with ALD-cirrhosis
  • Patients with NAFLD-cirrhosis
  • Patients with HCV who have undergone antiviral treatment (in whom it calculates HCC risk during the 3-year period after completion of antiviral treatment).
This information should be used to counsel patients when discussing the potential benefits and risks of HCC screening or to identify high-risk patients for HCC screening outreach or participation in clinical trials.

For data supporting the development of the HCC risk calculator:

For Patients

Hepatocellular carcinoma (HCC) is the most common form of liver cancer in patients with hepatitis or cirrhosis (scarring of the liver). Cirrhosis and long-term liver inflammation, which can occur from a viral infection like hepatitis C, increase the risk of malignant (cancer) cells forming in the liver. Liver cancer sometimes causes symptoms like a bump on the right side, pain in the abdomen, nausea and vomiting, yellowing of the eyes or skin, unusual fatigue, loss of appetite, weight loss or fever. If you have cirrhosis or hepatitis and develop any of these symptoms, you should check with your doctor.

Since liver cancer does not always cause symptoms, it is recommended that patients with cirrhosis of the liver receive scans (like ultrasound) every 6 months. If you have cirrhosis, your doctor may also determine that you need regular blood tests to detect liver cancer. Abnormal results found on scans or lab tests may require confirmatory testing like a CT (CAT) scan, MRI (magnetic resonance imaging) or liver biopsy. The prognosis and treatment of liver cancer depends on the number of tumors, the size of tumors, whether the cancer has spread beyond the liver, how well your liver is working and your overall medical health.

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About

Original Research

The research supporting the development of these HCC risk calculators was supported in part by grants:

  1. NIH/NCI: R01 CA196692 (PI George Ioannou)
  2. Department of Veterans: I01 CX001156 (PI George Ioannou)
The models were developed and internally validated using data from the national Veterans Affairs healthcare system. The models have not been externally validated yet. The contents do not represent the views of the US Department of Veterans Affairs of the United States Government.

Members of the research team involved in developing the models included:

  • Dr. George Ioannou, Director Hepatology, Veterans Affairs Puget Sound Healthcare System, Professor of Medicine, University of Washington, Seattle, WA
  • Dr. Lauren Beste, Director Veterans Affairs HIV, Hepatitis and Related Conditions (HHRC) Data and Analysis Group, Assistant Professor of Medicine, University of Washington, Seattle WA
  • Dr. Kristin Berry, Biostatistician, Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA
  • Dr. Pamela Green, Analyst, Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA

Site Development

  • Ted W. James, MD MSc is a gastroenterologist and a front-end webdeveloper in his free time.