REACH-B Score for HCC Risk in Chronic Hepatitis B
Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B; Yang 2011): sex, age, ALT, HBeAg status and HBV DNA, 0–17 points. Developed in untreated, non-cirrhotic adults aged 30–65 (REVEAL-HBV, n = 3,584) and validated in Hong Kong and Korea. Not for cirrhosis or patients on antiviral treatment.
Score interpretation
REACH-B 0–5 — low HCC risk group in untreated non-cirrhotic chronic hepatitis B.
→ HCC surveillance every 6 months with liver ultrasound plus/minus AFP per BSG/EASL/NICE guidelines; ensure optimal HBV management: check need for antiviral therapy (entecavir or tenofovir if HBV DNA detectable and ALT elevated); reassess annually; do not use REACH-B in cirrhotic patients (surveillance still mandatory regardless of score); lifestyle: alcohol abstinence, weight management, diabetes prevention.
REACH-B 6–11 — intermediate HCC risk group.
→ HCC surveillance every 6 months (ultrasound plus AFP); consider CT or MRI every 12 months if ultrasound technically limited; review antiviral therapy indication -- suppression of HBV DNA reduces HCC risk; hepatology outpatient follow-up; counsel patient on HCC symptoms (weight loss, RUQ pain, fatigue); ensure no concomitant risk factors (alcohol, metabolic syndrome, family history HCC).
REACH-B 12–17 — high HCC risk group (up to 47 % at 5 years at score 17).
→ Intensive HCC surveillance: ultrasound plus AFP every 6 months; consider CT or MRI every 12 months; initiate or optimise antiviral therapy urgently (adults: entecavir 0.5 mg OD or tenofovir disoproxil 245 mg OD or TAF 25 mg OD) -- reduces HCC incidence significantly; regular hepatology review every 3-6 months; any suspicious lesion on USS: urgent triple-phase CT or contrast-enhanced MRI for LI-RADS assessment; biopsy if LI-RADS 3-4 with no alternative explanation; consider referral to hepatobiliary MDT; family screening for HBV (HBsAg, anti-HBs for vaccination). Children: use a children's formulary.
Interpretation bands for the REACH-B Score. Apply clinical judgement and local guidance.
References
- Yang HI, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncol. 2011;12(6):568–574.
- NICE CG165. Hepatitis B (chronic): diagnosis and management. 2013.
Related
Curated clinical cross-links plus same-class fallbacks.
- Omalizumab (Dermatology — Chronic Urticaria) · Anti-IgE Monoclonal Antibody
- Cetuximab · Anti-EGFR Monoclonal Antibody — Head and Neck Cancer
- Cisplatin · Platinum Chemotherapy — Head and Neck Cancer
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Entecavir · Antiviral — Hepatitis B (Nucleoside Analogue)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
