Staged prediction models for perioperative virological suppression during urgent antiviral therapy in HBV-associated hepatocellular carcinoma

Not all patients with hepatitis B virus-related hepatocellular carcinoma (HBV-HCC) receive standard preoperative antiviral therapy. Effective viral control must therefore be achieved rapidly throughout the perioperative period from preoperative preparation to postoperative management, yet no individualised prediction tools tailored to this stage are currently available. To develop staged prediction models for perioperative virological suppression in patients with HBV-HCC undergoing urgent antiviral therapy, to guide individualised perioperative antiviral management and risk stratification, and to preliminarily explore the potential association between predictors of perioperative virological suppression and postoperative prognosis. In this single-centre cohort study, the preoperative cohort comprised 217 eligible patients, of whom 141 with complete perioperative data and 2-year follow-up formed the postoperative model cohort and survival analysis set. Multivariable logistic regression was used to construct the models, with internal validation performed via bootstrap correction and decision curve analysis. Survival was analysed using Cox regression and Kaplan–Meier estimation. The preoperative model (AUC = 0.843) identified baseline HBV DNA load, cirrhosis and globulin level as independent influencing factors. The postoperative model (AUC = 0.867) identified post-treatment HBV DNA reduction ratio, microvascular invasion (MVI), platelet count and tumour number as independent influencing factors. Bias-corrected C-statistics were 0.837 and 0.854, respectively. Exploratory analysis showed that MVI was associated with shorter 2-year recurrence-free survival (RFS) (HR = 1.918, 95% CI: 1.222–3.010, P = 0.005). The staged models developed in this study may provide a reference for individualised perioperative antiviral management in patients with HBV-HCC, and effective preoperative antiviral therapy is of great importance for achieving virological suppression throughout the perioperative period. Preliminary analysis suggests that MVI may be a factor associated with both poor perioperative virological suppression and early postoperative recurrence.