Development and validation of a modified PAGE-B score based nomogram for predicting hepatocellular carcinoma in antiviral-treated chronic hepatitis B patients with metabolic dysfunction.

OBJECTIVE: This study aimed to construct and validate a nomogram to predict the long-term incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) and metabolic dysfunction (MD) receiving antiviral therapy. METHODS: 809 individuals with hepatitis B combined with metabolic dysfunction who received antiviral therapy between 2009 and 2023 were randomly assigned to the training and validation cohorts in a 6:4 ratio using simple randomization performed with the sample function in R software (version 4.3.2). Independent risk factors for HCC were identified by Cox regression analysis, and a nomogram was subsequently constructed. The model’s performance was evaluated using calibration curves, decision curve analysis (DCA), and the area under the receiver operating characteristic curve (AUC). RESULTS: Independent predictors of HCC development identified by multivariate Cox regression included lymphocyte count, the Triglyceride-Glucose index, and the modified PAGE-B score. These were incorporated into a nomogram with a total score range of 0 to 200 for risk prediction. The nomogram yielded a 3-year AUC of 0.828, numerically higher than established scores; however, DeLong tests confirmed no statistically significant superiority. Using the nomogram for risk stratification, the 5-year cumulative HCC incidence in the derivation cohort was 2.5% in the low-risk, 9.7% in the medium-risk, and 20.0% in the high-risk group. The validation cohort showed corresponding incidence rates of 0.8%, 12.7%, and 18.5%. CONCLUSION: Our nomogram demonstrated favorable discriminative ability and calibration accuracy for predicting HCC risk among antiviral-treated patients with CHB and MD. Patients stratified into the high-risk group (scores > 151) could be prioritized for intensified surveillance, highlighting the model’s utility in risk-stratified clinical management. CLINICAL TRIAL NUMBER: Not applicable.