替诺福韦与恩替卡韦在国际慢性乙型肝炎联盟中预防肝细胞

StephenW

Am J Gastroenterol. 2019 Oct 11. doi: 10.14309/ajg.0000000000000428. [Epub ahead of print]
Tenofovir Versus Entecavir for Hepatocellular Carcinoma Prevention in an International Consortium of Chronic Hepatitis B.
Hsu YC, Wong GL1, Chen CH2, Peng CY3, Yeh ML4, Cheung KS5, Toyoda H6, Huang CF4, Trinh H7, Xie Q8, Enomoto M9, Liu L10, Yasuda S6, Tanaka Y11, Kozuka R9, Tsai PC4, Huang YT12, Wong C13, Huang R14, Jang TY4, Hoang J15, Yang HI16, Li J17, Lee DH18, Takahashi H19, Zhang JQ20, Ogawa E21, Zhao C22, Liu C22, Furusyo N21, Eguchi Y19, Wong C13, Wu C14, Kumada T6, Yuen MF5, Yu ML4, Nguyen MH15.
Author information

1
    Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China.
2
    Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
3
    Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan.
4
    Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
5
    Department of Medicine, the University of Hong Kong, Hong Kong SAR, China.
6
    Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
7
    San Jose Gastroenterology, San Jose, California, USA.
8
    Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
9
    Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan.
10
    Department of Infection Disease, the Third Hospital of Kumming City, Kumming, People's Republic of China.
11
    Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
12
    Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
13
    Wong Clinics, San Francisco, California, USA.
14
    Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China.
15
    Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, the United States of America.
16
    Genomics Research Center, Academia Sinica, Taipei, Taiwan.
17
    Palo Alto Medical Foundation, Mountain View Division, Mountain View, California, USA.
18
    Department of Gastroenterology, Good Gang-An Hospital, Busan, Sourth Korea.
19
    Department of Internal Medicine, Saga University Hospital, Saga, Japan.
20
    Chinese Hospital, San Francisco, California, USA.
21
    Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
22
    Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital affiliated to Shanghai University of T.C.M., Shanghai, People's Republic of China.

Abstract
INTRODUCTION:

It is unclear whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) differ in their effectiveness for preventing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).
METHODS:

This retrospective cohort study analyzed an international consortium that encompassed 19 centers from 6 countries or regions composed of previously untreated CHB patients then treated with either ETV or TDF monotherapy. Those who developed HCC before antiviral treatment or within 1 year of therapy were excluded. The association between antiviral regimen and HCC risk was evaluated using competing-risk survival regression. We also applied propensity score matching (PSM) to 1:1 balance the 2 treatment cohorts. A total of 5,537 patients were eligible (n = 4,837 received ETV and n = 700 received TDF) and observed for HCC occurrence until December 23, 2018. Before PSM, the TDF cohort was significantly younger and had generally less advanced diseases.
RESULTS:

In the unadjusted analysis, TDF was associated with a lower risk of HCC (subdistribution hazard ratio [SHR], 0.45; 95% confidence interval [CI], 0.26-0.79; P = 0.005). The multivariable analysis, however, found that the association between TDF and HCC no longer existed (SHR, 0.81; 95% CI, 0.42-1.56; P = 0.52) after adjustment for age, sex, country, albumin, platelet, α-fetoprotein, cirrhosis, and diabetes mellitus. Furthermore, the PSM analysis (n = 1,040) found no between-cohort differences in HCC incidences (P = 0.51) and no association between regimens (TDF or ETV) and HCC risk in the multivariable-adjusted analysis (adjusted SHR, 0.89; 95% CI, 0.41-1.92; P = 0.77).
DISCUSSION:

TDF and ETV did not significantly differ in the prevention of HCC in patients with CHB.

PMID:
    31634265
DOI:
    10.14309/ajg.0000000000000428

StephenW

我是J胃肠。 2019年10月11日.doi：10.14309 / ajg.0000000000000428。 [Epub提前发布]
替诺福韦与恩替卡韦在国际慢性乙型肝炎联盟中预防肝细胞癌的关系。
徐YC，黄GL1，陈CH2，彭CY3，叶ML4，张KS5，丰田H6，黄CF4，Trinh H7，谢Q8，江本M9，刘L10，安田S6，田中Y11，小冢R9，蔡PC4，黄YT12 ，Wong C13，Huang R14，Jang TY4，Hoang J15，Yang HI16，Li J17，Lee DH18，Takahashi H19，Zhang JQ20，Ogawa E21，Zhao C22，Liu C22，Furusyo N21，Eguchi Y19，Wong C13，Wu C14，Kumada T6，Yuen MF5，Yu ML4，Nguyen MH15。
作者信息

1个
    香港中文大学，香港特别行政区医学与治疗学系。
2
    台湾高雄市长庚纪念医院和长庚大学医学院内科。
3
    台湾台中中国医科大学附属医院消化内科。
4
    高雄医科大学内科，台湾高雄。
5
    中国香港特别行政区香港大学医学系。
6
    日本大垣市大垣市立医院消化内科。
7
    美国加利福尼亚州圣何塞，圣何塞胃肠病学。
8
    上海交通大学医学院附属瑞金医院传染病科，上海。
9
    日本大阪市立大学医学研究生院肝病学系。
10
    中华人民共和国昆明市昆明市第三医院感染病科。
11
    名古屋市立大学医学研究科病毒与肝病学系，日本名古屋。
12
    中国科学院统计研究所，台湾台北。
13
    Wong诊所，美国加利福尼亚州旧金山。
14
    南京大学医学院，南京鼓楼医院，传染病科，江苏南京。
15
    美利坚合众国加利福尼亚州帕洛阿尔托市斯坦福大学医学中心消化内科和肝病科。
16
    中国台湾省中央研究院基因组学研究中心。
17
    美国加利福尼亚州山景城帕洛阿尔托医学基金会。
18岁
    韩国Sourth釜山Good Gang-An医院消化内科。
19
    日本佐贺县佐贺大学附属医院内科。
20
    美国加利福尼亚州旧金山中国医院。
21
    日本福冈九州大学医院普通内科。
22
    上海市上海中医药大学附属曙光医院肝病研究所肝硬化科

抽象
介绍：

目前尚不清楚恩替卡韦（ETV）和替诺福韦富马酸替诺福韦（TDF）在预防慢性乙型肝炎（CHB）患者肝细胞癌（HCC）方面的有效性是否不同。
方法：

这项回顾性队列研究分析了一个国际财团，该财团包括6个国家或地区的19个中心，这些中心由先前未接受治疗的CHB患者组成，然后接受ETV或TDF单一疗法治疗。在抗病毒治疗之前或治疗1年内发展为HCC的患者被排除在外。使用竞争风险生存回归评估抗病毒方案与HCC风险之间的关联。我们还将倾向评分匹配（PSM）应用于1：1平衡了两个治疗队列。共有5537例患者符合条件（n = 4837接受了ETV，n = 700接受了TDF），并观察到HCC的发生，直到2018年12月23日。在PSM之前，TDF队列明显年轻，并且一般来说病情较轻。
结果：

在未经调整的分析中，TDF与较低的HCC风险相关（子分布危险比[SHR]为0.45； 95％置信区间[CI]为0.26-0.79； P = 0.005）。然而，多变量分析发现，在调整了年龄，性别，国家，白蛋白，血小板，甲胎蛋白后，TDF和肝癌之间的关联不再存在（SHR，0.81； 95％CI，0.42-1.56； P = 0.52）。 ，肝硬化和糖尿病。此外，PSM分析（n = 1,040）在多变量校正分析中（校正后的SHR，0.89； 95）未发现人群间HCC发生率差异（P = 0.51），而且方案（TDF或ETV）与HCC风险之间也没有关联。 ％CI，0.41-1.92； P ＝ 0.77）。
讨论：

TDF和ETV在CHB患者预防HCC方面无显着差异。

PMID：
    31634265
DOI：
    10.14309 / ajg.0000000000000428