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Background Current European and American guidelines provide no specific HCC surveillance recommendations for patients with chronic hepatitis B (CHB) who have achieved HBsAg loss, despite a lower HCC incidence than patients who remain chronically infected; target groups remain those with cirrhosis, men >40 years, women >50 years, and PAGE-B score ≥10. We evaluated HCC risk after HBsAg loss by age, sex, cirrhosis, and diabetes, and evaluated PAGE-B and modified PAGE-B (mPAGE-B) scores.Methods Using a territory-wide electronic database in Hong Kong, we included adults with monoinfected CHB who cleared HBsAg from Jan 2000 to Dec 2020, followed until Mar 2025. Exclusions were liver transplantation or HCC before HBsAg loss and follow-up <6 months. Annual HCC incidence was estimated with death as a competing risk. We calculated the 5-year integrated time-dependent area under the receiver operating characteristic curve (itAUROC) for PAGE-B and mPAGE-B. Cirrhosis was defined by diagnosis codes, fibrosis-4 index >3.25, and/or aspartate aminotransferase to platelet ratio index >2.Results Of 9,733 patients included (mean age 57.4±13.8 years, 40.0% female, 13.1% cirrhosis, 21.4% diabetes), 181 developed HCC at a median follow-up of 9.2 years. Annual HCC incidence was 0.47% with cirrhosis and 0.11% without cirrhosis ( IDDF2026-ABS-0285 Figure 1). In men without cirrhosis, the annual HCC incidence was 0.01% for HBsAg loss ≤40 years, 0.08% for 41 - 50 years, and 0.18% for >50 years (IDDF2026-ABS-0285 Figure 2). In women without cirrhosis, the annual HCC incidence was 0.01% for HBsAg loss ≤50 years, 0.06% for 51 - 60 years, and 0.13% for >60 years (IDDF2026-ABS-0285 Figure 3). In patients without cirrhosis, the 5-year itAUROC was 0.749 for PAGE-B and 0.768 for mPAGE-B. Annual HCC incidence was 0.17% for PAGE-B ≥12 (IDDF2026-ABS-0285 Figure 4) and 0.17% for mPAGE-B ≥11 (IDDF2026-ABS-0285 Figure 5). Without cirrhosis, the annual HCC incidence was 0.17% with diabetes and 0.09% without diabetes (IDDF2026-ABS-0285 Figure 6).Conclusions Patients with HBsAg loss who have cirrhosis warrant HCC surveillance. When cirrhosis is absent, thresholds are met by men >50 years and women >60 years at HBsAg loss, and by those with diabetes. PAGE-B and mPAGE-B scores accurately stratify HCC risk; cut-offs after HBsAg loss should be higher than those used in CHB.Abstract IDDF2026-ABS-0285 Figure 1Abstract IDDF2026-ABS-0285 Figure 2Abstract IDDF2026-ABS-0285 Figure 3Abstract IDDF2026-ABS-0285 Figure 4Abstract IDDF2026-ABS-0285 Figure 5Abstract IDDF2026-ABS-0285 Figure 6