{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T11:59:31Z","timestamp":1770292771540,"version":"3.49.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the probability of hepatocellular carcinoma (HCC) in a large number of gray-zone (GZ) patients with chronic hepatitis B (CHB) in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The patients with CHB who were diagnosed and treated in our hospital from January 2013 to January 2023 were analyzed retrospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>According to the different levels of HBeAg, ALT and HBV DNA, GZ patients were divided into four categories: (1) Gray zone A (GZ-A): HBeAg positive, normal ALT level, HBV DNA \u2264 10<jats:sup>6<\/jats:sup> IU\/ml; (2) Gray zone B (GZ-B): HBeAg positive, ALT&amp;gt;ULN, HBV DNA \u2264 2 \u00d7 10<jats:sup>4<\/jats:sup> IU\/ml; (3) Gray zone C (GZ-C): HBeAg negative, normal ALT level, HBV DNA \u2265 2 \u00d7 10<jats:sup>3<\/jats:sup> IU\/ml; and (4) Gray zone D (GZ-D): HBeAg negative, ALT &amp;gt; ULN, serum HBV DNA \u2264 2 \u00d7 10<jats:sup>3<\/jats:sup> IU\/ml. This observational study showed that after adjustment using inverse probability of treatment weighting (IPTW), the probability of developing HCC in the GZ group was similar to that in the immune-tolerant, HBeAg-positive immune active, and inactive groups. The IPTW-adjusted analysis revealed that the probability of developing HCC in the GZ-B subgroup was similar to that in the immune-active and HBeAg-negative immune-active groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The GZ group and GZ-B subgroup have a higher risk of HCC. Anti-hepatitis B virus therapy should be considered as early as possible for patients in the GZ group, especially in the GZ-B subgroup.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1464981","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T06:39:27Z","timestamp":1735022367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Probability analysis of hepatocellular carcinoma in hepatitis patients in the gray 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