J Viral Hepat. 2018 Jan 6. doi: 10.1111/jvh.12855. [Epub ahead of print]
Entecavir and Tenofovir Reduce Hepatitis B Virus-related Hepatocellular Carcinoma Recurrence More Effectively than Other Antivirals.Cho H1, Ahn H1, Lee DH1,2, Lee JH1, Jung YJ2, Chang Y1, Nam JY1, Cho YY1, Lee DH3, Cho EJ1, Yu SJ1, Lee JM3, Kim YJ1, Yoon JH1. Author information 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.2Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.3Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
AbstractNucleos(t)ide analogues (NAs) have been shown to decrease the risk of hepatocellular carcinoma (HCC) recurrence. This study evaluated whether high-potency NAs (entecavir and tenofovir disoproxil fumarate [TDF]) reduce the risk of tumor recurrence more potently than low-potency NAs after curative treatment of hepatitis B virus (HBV)-related HCC. This study included 607 consecutive HBV-related HCC patients treated with surgical resection or radiofrequency ablation. The patients were categorized into three groups according to antiviral treatment: group A (no antiviral; n=261), group B (low-potency NA; n=90), and group C (high-potency NA; n=256). The primary endpoint was recurrence-free survival (RFS). During the duration of follow-up, the median RFS was 29.4, 25.1, and 88.2 months in groups A, B, and C, respectively (P<0.001, log-rank test). The multivariate Cox analysis indicated that group C had a significantly longer RFS than both group A (adjusted hazard ratio [HR]=0.39, P<0.001) and group B (adjusted HR=0.47, P<0.001). When baseline characteristics were balanced using inverse probability weighting, group C still had a significantly longer RFS than group A (adjusted HR=0.46, P<0.001) and group B (adjusted HR=0.59, P=0.007). Group C had significantly lower risk of viral breakthrough than group B (HR=0.19, P<0.001). Viral breakthrough was an independent risk factor for shorter RFS among groups B and C (adjusted HR=2.03, P=0.007, time-dependent Cox analysis). Antiviral agents with high genetic barrier to resistance (entecavir and TDF) reduced the risk of HCC recurrence compared with other antivirals and no antiviral treatment, especially in patients with high baseline viral load. This article is protected by copyright. All rights reserved.