与恩替卡韦相比，替诺福韦在中国慢性HBV感染患者中的肝细

StephenW

Tenofovir Is Associated With Lower Risk of Hepatocellular Carcinoma Than Entecavir in Patients With Chronic HBV Infection in China
Terry Cheuk-Fung Yip1,2
, Vincent Wai-Sun Wong1,2,3
, Henry Lik-Yuen Chan1,2,3
, Yee-Kit Tse1,2
, Grace Chung-Yan Lui2
, Grace Lai-Hung Wong1,2,3,∗,'Correspondence information about the author Grace Lai-Hung WongEmail the author Grace Lai-Hung Wong
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DOI: https://doi.org/10.1053/j.gastro.2019.09.025 |
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Background & Aims

There have been conflicting results from studies comparing the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection treated with tenofovir disoproxil fumarate (TDF) vs those treated with entecavir. We compared the effects of TDF vs entecavir on HCC risk in a large cohort of patients with chronic HBV infection in China.
Methods

We performed a retrospective study of consecutive adults with chronic HBV infection who initially received treatment with entecavir or TDF, for at least 6 months, from January 2008 through June 2018. Patients who had cancers or liver transplantation before or within the first 6 months of treatment were excluded. Propensity score weighting and 1:5 matching were used to balance the clinical characteristics between the 2 groups. Fine-Gray model was used to adjust for competing risk of death and liver transplantation.
Results

We analyzed data from 29,350 patients (mean age, 52.9 ± 13.2 years; 18,685 men [63.7%]); 1309 were first treated with TDF (4.5%) and 28,041 were first treated with entecavir (95.5%). TDF-treated patients were younger (mean age, 43.2 years vs 53.4 years) and a lower proportion had cirrhosis (38 patients [2.9%] vs 3822 patients treated with entecavir [13.6%]). At a median follow-up time of 3.6 years after treatment began (interquartile range, 1.7–5.0 years), 8 TDF-treated patients (0.6%) and 1386 entecavir-treated patients (4.9%) developed HCC. Patients’ clinical characteristics were comparable after propensity score weighting. TDF treatment was associated with a lower risk of HCC than entecavir treatment after propensity score weighting (weighted subdistribution hazard ratio, 0.36; 95% confidence interval 0.16–0.80; P = .013) and 1:5 matching (weighted subdistribution hazard ratio, 0.39; 95% confidence interval 0.18–0.84; P = .016).
Conclusions

In a retrospective analysis of 29,350 patients with chronic HBV infection in China, treatment with TDF was associated with a lower risk of HCC than treatment with entecavir, over a median follow-up time of 3.6 years.
Keywords:
Antiviral Therapy, Liver Cancer, Nucleos(t)ide Analogues, PS Matching

StephenW

与恩替卡韦相比，替诺福韦在中国慢性HBV感染患者中的肝细胞癌风险更低
叶卓丰叶1,2
，Vincent Wai-Sun Wong1,2,3
，陈力源1,2,3
，Yee-Kit Tse1,2
吕中恩2
，Grace Lai-Hong Wong1,2,3，∗，'有关作者Grace Lai-Hong Wong的通讯信息给作者Grace Lai-Hung Wong发电子邮件
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DOI：https：//doi.org/10.1053/j.gastro.2019.09.025 |
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背景与目标

比较将替诺福韦酯富马酸酯（TDF）与恩替卡韦治疗的慢性乙型肝炎病毒（HBV）感染患者的肝细胞癌（HCC）风险比较的研究得出了相互矛盾的结果。我们比较了中国大批慢性HBV感染患者中TDF和恩替卡韦对HCC风险的影响。
方法

我们对2008年1月至2018年6月开始接受恩替卡韦或TDF治疗的连续慢性HBV感染连续成人进行了至少6个月的回顾性研究。在治疗前或治疗前6个月内患有癌症或肝移植的患者被排除在外。倾向得分加权和1：5匹配用于平衡两组之间的临床特征。精细灰色模型用于调整死亡和肝移植的竞争风险。
结果

我们分析了29,350名患者的数据（平均年龄52.9±13.2岁； 18,685名男性[63.7％]）；首先使用TDF（4.5％）治疗1309例，首先使用恩替卡韦（95.5％）治疗28,041例。 TDF治疗的患者较年轻（平均年龄43.2岁vs 53.4岁），肝硬化的比例较低（38例[2.9％]对3822例接受恩替卡韦治疗的患者[13.6％]）。在开始治疗后3.6年的中位随访时间（四分位数范围为1.7-5.0年）中，有8例接受TDF治疗的患者（0.6％）和1386例接受恩替卡韦治疗的患者（4.9％）发生了HCC。倾向评分加权后，患者的临床特征具有可比性。倾向评分加权（加权子分布风险比，0.36； 95％置信区间0.16--0.80； P = 0.013）和1：5匹配（加权子分布风险比， 0.39; 95％置信区间0.18--0.84; P = .016）。
结论

在对中国29,350例慢性HBV感染患者的回顾性分析中，在3.6年的中位随访时间内，与恩替卡韦治疗相比，使用TDF进行治疗的HCC风险较低。
关键字：
抗病毒治疗，肝癌，核仁类似物，PS匹配