Not all cirrhosis patients need the same level of liver cancer surveillance — and a new study suggests a better tool exists to tell them apart. A multicenter cohort study of 1,531 patients across three Dutch centers found that the Toronto HCC Risk Index (THRI) significantly outperformed the widely validated aMAP score in identifying cirrhosis patients at near-negligible risk for hepatocellular carcinoma (HCC). THRI factors in age, sex, platelet count, and — crucially — the cause of cirrhosis, giving it an edge in a patient population where 60% had nonviral liver disease.

The key finding: patients classified as low-risk by THRI had a 5-year HCC incidence of just 0.5%, compared to 2.9% for those flagged as low-risk by aMAP. Among aMAP's low-risk group, two-thirds were actually reclassified as higher risk by THRI — and went on to develop HCC at a much higher rate.

By the Numbers:

• 196 out of 1,531 patients developed HCC during follow-up
• 5-year HCC risk for THRI low-risk patients: 0.5% vs. 2.9% for aMAP low-risk
• THRI sensitivity at the low-risk cutoff: 98.8% vs. 87.2% for aMAP
• Only 32% of aMAP low-risk patients were also low-risk by THRI

Why it matters: Personalized HCC surveillance is a growing priority, but it only works if the risk scores are reliable. THRI's superior sensitivity means fewer high-risk patients are missed — potentially enabling safer, evidence-backed decisions to reduce surveillance frequency in truly low-risk cirrhosis patients.