The feasibility and performance of predicting
hepatocellular carcinoma (HCC) using a combined
albumin-
bilirubin (ALBI) and fibrosis-4 (FIB-4)-based model remain unclear in patients with compensated
cirrhosis and
chronic hepatitis B (CHB) receiving long-term nucleos(t)ide analog (NA)
therapy. We enrolled 1158 NA-naïve patients with compensated
cirrhosis and CHB treated with
entecavir or
tenofovir disoproxil fumarate. The patients' baseline characteristics, hepatic reserve, and
fibrosis indices were analyzed. The combination of ALBI and FIB-4 was used to develop a prediction model of HCC. In this cohort, the cumulative incidence rates of HCC at 3, 5, and 10 years were 8.1%, 13.2%, and 24.1%, respectively. The combination of ALBI and FIB-4,
Diabetes mellitus, and
Alpha-fetoprotein (AFDA) were independent risk factors for HCC. The combined ALBI and FIB-4-based prediction model (i.e., AFDA) stratified the cumulative risk of HCC into three groups (with risk scores of 0, 1-3, 4-6) among all patients (P < 0.001). AFDA exhibited the highest area under the receiver operating characteristic (0.6812) for predicting HCC, which was higher than those of aMAP (0.6591), mPAGE-B (0.6465), CAMD (0.6379), and THRI (0.6356) and significantly higher than those of PAGE-B (0.6246), AASL-HCC (0.6242), and HCC-RESCUE (0.6242). Patients with a total score of 0 (n = 187, 16.1% of total patients) had the lowest cumulative HCC incidence of 3.4% at 5 years. The combined ALBI and FIB-4-based prediction model can stratify the risk of HCC in patients with compensated
cirrhosis and CHB receiving NA
therapy.