REACH-B Score for Hepatocellular Carcinoma (HCC)

REACH-B Score
Sex
Age
ALT Level
HBeAg Status
HBV DNA Level
REACH-B Score: 0
Very Low Risk
REACH-B Score 0-5. 3-year HCC risk: 0.0-0.1% 5-year HCC risk: 0.0-0.2% 10-year HCC risk: 0.0-0.5% Routine surveillance recommended.
Estimates risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B.

Formula

Addition of the selected points: Variable Points Sex Female 0 Male 2 Age, years 30–34 0 35–39 1 40–44 2 45–49 3 50–54 4 55–59 5 60–65 6 ALT , U/L <15 0 15–44 1 ≥45 2 HBeAg Negative 0 Positive 2 Hepatitis B virus DNA level, copies/mL <300 (undetectable) 0 300–9,999 0 10,000–99,999 3 100,000–999,999 5 ≥10 6 4* *The risk score attributed to HBV DNA ≥10 6 copies/mL was less than that for HBV DNA of 100,000–999,999 copies/mL because most patients with HBV DNA ≥10 6 copies/mL were also HBeAg positive, thus sharing the associated higher score for this category.

Pearls / Pitfalls

Derived and validated primarily in East Asian cohorts; may have limited applicability to other populations. Excludes factors such as alpha fetoprotein and alcohol use, which are also known to be associated with progression to cirrhosis and HCC.

Management

Refer to AASLD guidelines for treatment of hepatocellular carcinoma.

Advice

May help guide decision to initiate treatment in patients with chronic hepatitis B and thus help prevent progression to HCC.

More Information

Interpretation: REACH-B Score HCC risk 3-year 5-year 10-year 0 0.0% 0.0% 0.0% 1 0.0% 0.0% 0.1% 2 0.0% 0.0% 0.1% 3 0.0% 0.1% 0.2% 4 0.0% 0.1% 0.3% 5 0.1% 0.2% 0.5% 6 0.1% 0.3% 0.7% 7 0.2% 0.5% 1.2% 8 0.3% 0.8% 2.0% 9 0.5% 1.2% 3.2% 10 0.9% 2.0% 5.2% 11 1.4% 3.3% 8.4% 12 2.3% 5.3% 13.4% 13 3.7% 8.5% 21.0% 14 6.0% 13.6% 32.0% 15 9.6% 21.3% 46.8% 16 15.2% 32.4% 64.4% 17 23.6% 47.4% 81.6%

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