This study provides robust real-world evidence validating the PAGE-B score as an effective and practical tool for predicting hepatocellular carcinoma risk among Brazilian patients with chronic hepatitis B receiving long-term antiviral therapy. The higher incidence of HCC observed, particularly among older male patients with thrombocytopenia and advanced fibrosis, underscores the need for region-specific risk stratification strategies. By confirming the discriminatory capacity of PAGE-B in a diverse Brazilian population and highlighting differences related to antiviral therapy, these findings support its incorporation into routine clinical practice to optimize surveillance intensity and improve early HCC detection in high-risk HBV carriers.