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

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. 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). 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%. 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. Not applicable.