Introduction
Chronic hepatitis B (CHB) infection remains a major global health challenge due to its high propensity to progress to hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality worldwide. In parallel, the rising prevalence of metabolic dysfunction and metabolic dysfunction-associated steatotic liver disease (MASLD)—formerly known as nonalcoholic fatty liver disease (NAFLD)—has reshaped the landscape of liver-related morbidity. These metabolic conditions contribute independently to liver injury and carcinogenesis, potentially compounding risks in patients with CHB. Despite this evolving epidemiology, accurate HCC risk stratification tools tailored to patients with coexisting metabolic dysfunction are lacking.
This article examines a recent multicenter cohort study by Patmore et al. published in Alimentary Pharmacology and Therapeutics (2025), which investigates the interplay of metabolic dysfunction and MASLD in CHB patients and evaluates the applicability of the platelet-albumin-age HBV (PAGE-B) score in predicting HCC and other liver-related events in this high-risk population.
