BACKGROUND/AIMS Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). METHODS Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. RESULTS The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65-0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61-0.68; untreated models: 0.51-0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. CONCLUSION The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.

中文翻译：

---

慢性乙型肝炎患者长期接受抗病毒治疗，肝细胞癌预测模型的性能会下降。

背景/目的现有的肝细胞癌（HCC）预测模型主要源自治疗前或早期治疗参数。我们重新评估了慢性乙型肝炎 (CHB) 患者在长期抗病毒治疗 (AVT) 期间的 17 个 HCC 模型表现的动态变化。方法 在987例接受长期恩替卡韦治疗的CHB患者中，660例患者有8年的随访数据。使用 AVT 2.5 年、3 年、3.5 年、4 年、4.5 年和 5 年的治疗值计算模型评分，以预测三年 HCC 发生率。模型性能通过受试者工作曲线下面积 (AUROC) 进行评估。通过对数秩检验评估区分不同 HCC 风险水平的原始模型临界值。结果 当使用 2.5 至 5 年的治疗评分时，17 个 HCC 模型的 AUROC 变化范围为 0.51 至 0.78。具有肝硬化变量的模型显示数值较高的 AUROC（治疗、未治疗或混合治疗模型的 AUROC 汇总为 0.65-0.73）比未处理的模型（处理或混合模型：0.61-0.68；未处理模型：0.51-0.59）。使用原始临界值分层为低、中、高风险水平不能再反映真实的 HCC 发病率，对于无肝硬化模型使用 3.5 年 AVT 后的评分，对于肝硬化模型使用 AVT 4 年后的评分。结论 现有的 HCC 预测模型，尤其是没有肝硬化变量的模型，在长期 AVT 的 CHB 患者中表现下降。有必要优化现有模型或开发新模型，以便在长期 AVT 期间更好地预测 HCC。