核苷类似物（NA）的长期治疗能够降低代偿性肝硬化（CC）慢性乙型肝炎（CHB）患者出现失代偿和肝细胞癌（HCC）的风险。然而，抗病毒治疗对失代偿和HCC风险的差异疗效目前尚未完全明确。因此，我们对NA治疗的CC CHB患者的疾病状态转化进行了调查，重点关注失代偿事件特定的HCC风险。我们对1163名NA治疗的CC CHB患者进行了长达七年的随访，每六个月进行一次。通过Kaplan-Meier法和竞争风险模型分析了HCC的累积发生率和风险。使用多状态模型估计了不同疾病状态向HCC的转化概率。HCC是首个与肝脏相关的事件，五年累积发病率为9.0%，之后是失代偿（8.3%，包括7.9%的非出血失代偿和2.4%的静脉曲张出血）和0.2%的死亡。与CC阶段相比，失代偿阶段的五年累积HCC发病率显著提高（27.6% vs. 9.1%；HR=2.42，95%CI:1.24,4.71）。此外，非出血失代偿事件的五年转化概率高于出血失代偿（27.6% vs. 15.8%；HR=2.69，95%CI:1.41,4.17）。病毒抑制调节了在治疗过程中向HCC的过渡风险（1年：HR=0.45，95%CI:0.28,0.73；3年：HR=0.23，95%CI:0.14,0.38）。开发了一个网络计算器，以便帮助HCC风险分层。在受到NA治疗的CC CHB患者中，HCC的风险高于失代偿的风险；更重要的是，不同的失代偿事件具有不同的HCC风险。 © 2023. 亚洲太平洋肝脏研究协会。

Long-term treatment with nucleoside analog (NA) reduces the risks for decompensation and hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients with compensated cirrhosis (CC). However, whether antiviral therapy has differential efficacy on the risks for decompensation and HCC is insufficiently elucidated. Therefore, we investigated the disease state transition, focusing on decompensation event-specific HCC risk in NA-treated CHB patients with CC.We prospectively followed up on 1163 NA-treated CHB patients with CC every six months for up to seven years. The cumulative incidence and risk of HCC were analyzed by the Kaplan-Meier method and competing risk model. The multistate model was used to estimate the transition probabilities to HCC from different disease states.HCC predominated the first liver-related events, with a 5-year cumulative incidence of 9.0%, followed by decompensation (8.3%, including 7.9% nonbleeding decompensation and 2.4% variceal bleeding) and 0.2% death. The decompensation stage had a significantly higher 5-year cumulative HCC incidence than the CC stage (27.6% vs. 9.1%; HR = 2.42, 95% CI: 1.24, 4.71). Furthermore, nonbleeding decompensation events had a higher 5-year transition probability to HCC than bleeding (27.6% vs. 15.8%; HR = 2.69, 95% CI: 1.41, 4.17). Viral suppression modified the on-treatment transition risk to HCC (1-year: HR = 0.45, 95% CI: 0.28, 0.73; 3-year: HR = 0.23, 95% CI: 0.14, 0.38). An online calculator was developed to facilitate HCC risk stratification.In NA-treated CHB patients with compensated cirrhosis, the risk was higher for HCC than for decompensation; more importantly, different decompensation events conferred distinct HCC risks.© 2023. Asian Pacific Association for the Study of the Liver.