替诺福韦与恩替卡韦治疗乙型肝炎病毒相关肝细胞癌手术切

StephenW

Hepatology. 2020 Apr 23. doi: 10.1002/hep.31289. [Epub ahead of print]
Tenofovir vs. Entecavir on Recurrence of Hepatitis B Virus-Related Hepatocellular Carcinoma after Surgical Resection.
Choi J1, Jo C2, Lim YS1.
Author information

1
    Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2
    Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Abstract

Studies have suggested that tenofovir disoproxil fumarate (TDF) treatment is associated with a significantly lower risk of hepatocellular carcinoma (HCC) occurrence when compared to entecavir (ETV) therapy in chronic hepatitis B patients. We aimed to compare HCC recurrence and survival of patients treated with TDF or ETV after surgical resection for hepatitis B virus (HBV)-related HCC. This historical cohort study included 1,695 consecutive patients treated with ETV (n=813) or TDF (n=882) after curative-intent hepatectomy for HBV-related HCC of Barcelona Clinic Liver Cancer stage 0 or A in Korea between 2010 and 2018. HCC recurrence and overall survival of patients were compared between ETV and TDF groups by propensity score-matched and multivariable-adjusted Cox regression analyses from the date of hepatectomy for HCC. Mean age of the study patients was 54.8 years and 1,294 patients (76.3%) were male. During median follow-up duration of 37.6 months with continued ETV or TDF therapy, 561 (33.1%) patients developed HCC recurrence, 144 (8.4%) died, and 22 (1.3%) received liver transplant. Compared with ETV, TDF therapy was associated with significantly higher recurrence-free (P=0.02) and overall survival (P=0.03) rates by propensity score-matched analysis. By multivariable-adjusted analysis, TDF group was associated with significantly lower rates of HCC recurrence (HR, 0.82; 95% CI, 0.68-0.98; P=0.03), and death or transplantation (HR, 0.62; 95% CI, 0.44-0.88; P=0.01). TDF therapy was an independent protective factor for both early (<2 years; HR, 0.79; P=0.03) and late (≥2 years; HR, 0.68; P=0.03) postoperative HCC recurrence. CONCLUSION: Among patients who underwent curative hepatectomy for HBV-related HCC, TDF therapy was associated with a significantly lower risk of HCC recurrence and better overall patient survival compared to ETV therapy.

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KEYWORDS:

Chronic hepatitis B; Comparative effectiveness; Liver cancer; Nucleos(t)ide analogues; Tenofovir disoproxil fumarate

PMID:
    32324905
DOI:
    10.1002/hep.31289

StephenW

肝病学。 2020年4月23日。doi：10.1002 / hep.31289。 [Epub提前发行]
替诺福韦与恩替卡韦治疗乙型肝炎病毒相关肝细胞癌手术切除后复发。
崔J1，乔C2，林YS1。
作者信息

1个
    韩国首尔蔚山大学医学院附属牙山医学中心，肝病中心，消化内科。
2
    韩国首尔蔚山医学院大学牙山医学中心内科。

抽象

研究表明，与恩替卡韦（ETV）治疗相比，慢性乙型肝炎患者中替诺福韦富马酸替索罗非酯（TDF）治疗与肝细胞癌（HCC）发生的风险显着降低。我们的目的是比较因乙型肝炎病毒（HBV）相关的HCC手术切除后接受TDF或ETV治疗的患者的HCC复发和生存率。这项历史性队列研究包括2010年至2018年间，在韩国巴塞罗那临床肝癌0期或A期的HBV相关性肝癌根治性肝切除术后，连续接受了1695例接受ETV（n = 813）或TDF（n = 882）治疗的患者。HCC从肝切除术之日起，通过倾向评分匹配和多变量调整的Cox回归分析比较了ETV组和TDF组之间患者的复发和总生存率。研究患者的平均年龄为54.8岁，男性为1,294例（76.3％）。在继续进行ETV或TDF治疗的中位随访期37.6个月中，有561例（33.1％）的患者发生了HCC复发，死亡144例（8.4％），22例（1.3％）接受了肝移植。与ETV相比，通过倾向评分匹配分析，TDF治疗与无复发率（P = 0.02）和总生存率（P = 0.03）显着相关。通过多变量调整分析，TDF组与肝癌复发率显着降低（HR，0.82； 95％CI，0.68-0.98； P = 0.03）以及死亡或移植（HR，0.62； 95％CI，0.44-）相关。 0.88； P = 0.01）。 TDF治疗是术后早期（<2年； HR，0.79； P = 0.03）和晚期（≥2年； HR，0.68； P = 0.03）的独立保护因子。结论：与ETV疗法相比，在接受根治性乙肝切除术治疗HBV相关性HCC的患者中，TDF疗法可显着降低HCC复发风险并改善患者总体生存率。

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关键字：

慢性乙型肝炎；比较效力；肝癌;核苷类似物；替诺福韦酯富马酸

PMID：
    32324905
DOI：
    10.1002 / hep.31289