Reduced Incidence of Hepatocellular Carcinoma in Cirrhotic and Noncirrhotic Patients With Chronic Hepatitis B Treated With Tenofovir—A Propensity Score–Matched Study
Mindie H Nguyen Hwai-I Yang An Le Linda Henry Nghia Nguyen Mei-Hsuan Lee Jian Zhang Christopher Wong Clifford Wong Huy Trinh
The Journal of Infectious Diseases, Volume 219, Issue 1, 1 January 2019, Pages 10–18, https://doi.org/10.1093/infdis/jiy391
Published:
05 July 2018
Abstract
Background
The effect of newer oral anti–hepatitis B virus (HBV) medication, tenofovir disoproxil (TDF), on liver-related outcomes among Asians is limited. We examined the effect of TDF on the incidence of hepatocellular carcinoma (HCC) in an Asian population with chronic hepatitis B (CHB).
Methods
This was a retrospective cohort study of 6914 adults with chronic HBV monoinfection and no history of transplantation who were recruited from 6 US referral, community medical centers and a community based Taiwan cohort for a total of 774 patients who received TDF and 6140 who were not treated. Propensity score matching (PSM) for age, sex, HBV e antigen status, HBV DNA level, alanine aminotransferase (ALT) level, baseline cirrhosis status, and follow-up time was performed to balance the groups, resulting in 591 treated individuals and 591 untreated individuals. Kaplan-Meier analysis was used to estimate the cumulative risk of HCC. Cox proportional hazards models were run to estimate the HCC risk between groups.
Results
The 8-year cumulative HCC incidence was significantly higher in the PSM untreated group (20.13% vs 4.69%; P < .0001). Cirrhosis was a significant predictor for HCC (adjusted hazard ratio [aHR], 5.36; 95% confidence interval [CI], 2.73–10.51; P < .001). On multivariate analysis adjusted for age, sex, HBV DNA level, ALT level, and study site, TDF was associated with a 77% reduction in the risk of HCC (aHR, 0.23; 95% CI, .56–.92) in patients with cirrhosis and a 73% reduction (aHR, 0.27; 95% CI, .07–.98) in patients without cirrhosis.
Conclusions
Among cirrhotic and noncirrhotic Asian patients with CHB, TDF therapy was significantly associated with a reduction in the 8-year HCC cumulative incidence rate.
End-stage liver disease, hepatitis B, liver cancer, reduction, tenofovir, treatment
Topic:
liver cirrhosis carcinoma, hepatocellular hepatitis b, chronic hepatitis b virus tenofovir asian
替诺福韦-A倾向评分匹配研究治疗慢性乙型肝炎肝硬化患者肝细胞癌发病率降低
Mindie H Nguyen Hwai-I Yang An Le Linda Henry Nghia Nguyen Mei-Hsuan Lee Jian Zhang Christopher Wong Clifford Wong Huy Trinh
Journal of Infectious Diseases，第219卷，第1期，2019年1月1日，第10-18页，https：//doi.org/10.1093/infdis/jiy391
发布时间：
2018年7月5日
PSM未治疗组的8年累积HCC发生率显着较高（20.13％对4.69％; P <.0001）。肝硬化是HCC的重要预测因子（校正风险比[aHR]，5.36; 95％置信区间[CI]，2.73-10.51; P <.001）。根据年龄，性别，HBV DNA水平，ALT水平和研究部位调整的多变量分析，TDF与患者HCC风险降低77％（aHR，0.23; 95％CI，.56-.92）相关在没有肝硬化的患者中，肝硬化和减少73％（aHR，0.27; 95％CI，.07-.98）。
结论