主要是进行模糊进展、不确定进展和主要是回退（P-I-R）的分类，该分类不仅扩展到分期，还提供了关于肝纤维化动态变化的信息。然而，P-I-R分类的预后意义尚未阐明。因此，在本研究中，我们调查了P-I-R分类在预测治疗过程中临床结果上的实用性，该研究是对一个随机对照试验的扩展研究，该试验最初招募了1000例慢性乙型肝炎（CHB）患者，并经活检证实存在显著纤维化，并接受基于恩替卡韦的治疗超过7年。在治疗第72周进行了第二次活检的727例患者中，我们将646例拥有足够肝组织进行组织学评估的患者的P-I-R分类与Ishak分数变化进行比较。治疗前，进行进展、不确定进展和回退的病例分别占70%、17%和13%，治疗后72周，这些比例分别为20%、14%和64%，这可以进一步区分具有稳定Ishak分数的患者的组织学结果。7年期肝细胞癌（HCC）的累积发生率为回退病例的1.5%，不确定进展病例的4.3%，进展病例的22.8%（p<0.001）。在年龄、治疗方案、血小板计数、肝硬化、Ishak纤维化分数变化和Laennec分期进行调整后，治疗后进展病例在肝相关事件（失代偿、HCC、死亡/肝移植）的发生率方面有一个危险比为17.77（与治疗后回退相比；95%CI：5.55-56.88）。P-I-R分类不仅可以对组织学变化进行评估，还可以预测临床结果，为Ishak纤维化分数提供有意义的补充。版权所有©2023作者。由Wolters Kluwer Health, Inc.出版。

The predominantly Progressive, Indeterminate, and predominantly Regressive (P-I-R) classification extends beyond staging and provides information on dynamic changes of liver fibrosis. However, the prognostic implication of P-I-R classification is not elucidated. Therefore, in the present research, we investigated the utility of P-I-R classification in predicting the on-treatment clinical outcomes in an extension study on a randomized controlled trial which originally enrolled 1000 patients with chronic hepatitis B (CHB) and biopsy-proven histological significant fibrosis and treated them for more than 7 years with entecavir-based therapy. Among the 727 patients with a second biopsy at treatment week 72, we compared P-I-R classification and Ishak score changes in 646 patients with adequate liver sections for the histological evaluation. Progressive, Indeterminate, and Regressive cases were observed in 70%, 17%, and 13% of patients before treatments and 20%, 14%, and 64% after 72-week treatment, respectively, which could further differentiate the histological outcomes of patients with stable Ishak scores. The 7-year cumulative incidence of hepatocellular carcinoma (HCC) was 1.5% for the Regressive cases, 4.3% for the Indeterminate cases, and 22.8% for the Progressive cases (p<0.001). After adjusting for age, treatment regimen, platelet counts, cirrhosis, Ishak fibrosis score changes and Laennec staging, the post-treatment Progressive had a hazard ratio of 17.77 (vs. post-treatment Regressive; 95% CI: 5.55-56.88) for the incidence of liver related events (decompensation, HCC, death/liver transplantation).The P-I-R classification can be a meaningful complementary to the Ishak fibrosis score not only in evaluating the histological changes but also in predicting the clinical outcomes.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.