台湾恩替卡韦或替诺福韦治疗的初治慢性乙型肝炎相关性肝

StephenW

Five-year comparative risk of hepatocellular carcinoma development under entecavir or tenofovir treatment-naïve patients with chronic hepatitis B-related compensated cirrhosis in Taiwan
Tsung-Hui Hu  1 , Sherry Yueh-Hsia Chiu  2 , Po-Lin Tseng  1 , Chien-Hung Chen  1 , Sheng-Nan Lu  1 , Jing-Houng Wang  1 , Chao-Hung Hung  1 , Kwong-Ming Kee  1 , Ming-Tsung Lin  1 , Kuo-Chin Chang  1 , Meng-Chih Lin  3 , Rong-Nan Chien  4
Affiliations
Affiliations

    1
    Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
    2
    Department of Health Care Management, College of Management; and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
    3
    Division of Pulmonary and Critical Care Medicine and Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
    4
    Division of Hepato-Gastroenterology, Department of Internal Medicine, Linko Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

    PMID: 33111400 DOI: 10.1111/apt.16116

Abstract

Background: Comparative long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) for prevention of disease progression to hepatocellular carcinoma (HCC) among high-risk patients with chronic hepatitis B (CHB)-related compensated cirrhosis is controversial.

Aims: To compare the long-term efficacy of ETV and TDF in HCC prevention in patients with CHB-related cirrhosis, and to evaluate predictive risk factors for HCC development.

Methods: From January 2008 to March 2018, 894 treatment-naïve patients with CHB-related compensated cirrhosis on ETV or TDF were enrolled based on the longitudinal cohort study. Data were originally collected for 7.3 years of follow-up or after the launch of TDF in 2011. Only the 5-year cumulative incidence and risk factors of HCC were assessed.

Result: Total 678 and 216 patients received ETV and TDF, respectively. The cumulative risk of HCC at 1, 3 and 5 years of follow-up was 1.6%, 11.3% and 18.7%, respectively, in the ETV group; and 0.9%, 6.7% and 10.7%, respectively, in the TDF group (P = 0.0305). Univariate and adjusted-multivariable models revealed that platelet count, alpha-fetoprotein (AFP) levels and upper gastrointestinal (UGI) varices were independent risk factors for HCC development. TDF resulted in risk of HCC development compared to ETV with adjusted hazard ratios (aHRs) of 0.66 (95% confidence interval [CI]:0.40, 1.08; P = 0.0971), 0.69 (95% CI: 0.42, 1.14; P = 0.1488) and 0.66 (95% CI: 0.38, 1.14; P = 0.1407) under stepwise selection, propensity score adjustment, and propensity score matching multivariable models, respectively.

Conclusions: For treatment-naïve patients with CHB-related compensated cirrhosis with 5-year follow-up, after variable adjustments, propensity score approaches and subgroup analyses, TDF showed a lower rate of HCC development that did not reach statistical significance, compared to the ETV.

© 2020 John Wiley & Sons Ltd.

StephenW

台湾恩替卡韦或替诺福韦治疗的初治慢性乙型肝炎相关性肝硬化患者发生肝细胞癌的五年比较风险
胡宗辉1，赵雪霞2，曾宝霖1，陈建雄1，卢胜男1，王静雄1，洪朝雄1，广明记1，明-宗林1，张国钦1，林孟之3 3，钱荣南4
隶属关系
隶属关系

    1个
    台湾高雄市长庚纪念医院和长庚大学医学院内科肝消化科。
    2
    管理学院卫生保健管理系；长庚大学健康老化研究中心，台湾桃园。
    3
    台湾高雄市长庚纪念医院和长庚大学医学院，肺和重症医学科以及呼吸治疗科。
    4
    林桃长庚纪念医院和长庚大学医学院内科肝消化科，台湾桃园。

    PMID：33111400 DOI：10.1111 / apt.16116

抽象

背景：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）相关性代偿性肝硬化的高危患者中预防疾病进展为肝细胞癌（HCC）的长期疗效存在争议。

目的：比较ETV和TDF对CHB相关性肝硬化患者预防HCC的长期疗效，并评估HCC发展的预测危险因素。

方法：根据纵向队列研究，从2008年1月至2018年3月，对894名接受过ETV或TDF治疗的CHB相关性补偿性肝硬化的初治患者进行研究。最初收集的数据是对7.3年的随访或2011年TDF启动后的数据。仅评估了5年的HCC累积发生率和危险因素。

结果：分别有678名和216名患者接受了ETV和TDF。在ETV组，随访1年，3年和5年的HCC累积风险分别为1.6％，11.3％和18.7％。 TDF组分别为0.9％，6.7％和10.7％（P = 0.0305）。单变量和调整后的多变量模型显示，血小板计数，甲胎蛋白（AFP）水平和上消化道（UGI）静脉曲张是肝癌发生的独立危险因素。与ETV相比，TDF导致的HCC发生风险为0.66（95％置信区间[CI]：0.40，1.08; P = 0.0971），0.69（95％CI：0.42，1.14; P = 0.1488） ）和0.66（95％CI：0.38、1.14； P = 0.1407）分别在逐步选择，倾向得分调整和倾向得分匹配多变量模型下进行。

结论：对于初治为CHB相关性肝硬化的5年随访患者，经过变量调整，倾向评分方法和亚组分析后，TDF的HCC发生率较低，与统计学上相比没有统计学意义。 ETV。

分级为4 +©2020 John Wiley＆Sons Ltd.

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StephenW 发表于 2020-10-28 19:41
台湾恩替卡韦或替诺福韦治疗的初治慢性乙型肝炎相关性肝硬化患者发生肝细胞癌的五年比较风险
胡宗辉1，赵雪 ...

人总是要死的，但死的意义有不同。中国古时候有个文学家叫做司马迁的说过：“人固有一死，或重于泰山，或轻于鸿毛。”为人民利益而死，就比泰山还重；替法西斯卖力，替剥削人民和压迫人民的人去死，就比鸿毛还轻