Sinn DH, et al. - Hepatocellular carcinoma (HCC) incidence in chronic hepatitis B virus infected patients outside current treatment criteria was determined. In addition, risk factors associated with HCC development were assessed. Researchers analyzed a multi-center, retrospective cohort of 3,624 patients who were managed without antiviral treatment. There were 161 (4.4%) patients diagnosed with HCC over a median follow-up of 4.6 years. According to the Asian Pacific Association for the study of the Liver, the American Association for the Study of Liver Disease, and the European Association for the Study of the Liver criteria, 64.0%, 46.0%, and 33.5% patients, respectively, developed HCC outside treatment recommendation. Age, sex, hepatitis B e antigen, cirrhosis, alanine aminotransferase, and platelet levels were identified as independent factors associated with HCC development among patients who were outside treatment recommendation. Patients with a risk score ≥ 8, calculated using these factors, had a higher HCC incidence rate, even though they were outside current treatment criteria. These findings emphasize careful monitoring for HCC and making efforts to recognize patients at risk.