恩替卡韦和替诺福韦在增强治疗乙型肝炎病毒相关肝细胞癌

StephenW

The efficacies of entecavir and tenofovir in terms of enhancing prognosis after curative treatment of hepatitis B virus-related hepatocellular carcinoma
Ji Hyun Lee  1 , Beom Kyung Kim  2 , Soo Young Park  3 , Won Young Tak  3 , Jun Yong Park  2 , Do Young Kim  2 , Sang Hoon Ahn  2 , Dong Hyun Sinn  4 , Seung Up Kim  5
Affiliations
Affiliations

    1
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
    2
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
    3
    Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea.
    4
    Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. Electronic address: [email protected].
    5
    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea. Electronic address: [email protected].

    PMID: 33810942 DOI: 10.1016/j.ejim.2021.02.019

Abstract

Background/aims: Whether entecavir (ETV) or tenofovir disoproxil fumarate (TDF) affords the better prognosis after curative treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unclear. We compared recurrence and death rates between patients taking ETV and those taking TDF.

Methods: Between 2013 and 2017, patients with HBV-related HCC who had undergone hepatic resection (n=421) or radiofrequency ablation (n=305) as first-line anti-HCC treatment in three institutes were consecutively enrolled. All patients received ETV or TDF as a first-line antiviral. The cumulative probabilities of recurrence and death were assessed. We adjusted for viral factors, including the HBV-DNA load, and tumor and demographic factors.

Results: During the study period (median 46.6 [interquartile range 25.3-58.9] months), 227 patients experienced recurrence and 53 died. In the ETV (n=405) and TDF (n=321) groups, the annual incidences of recurrence (10.61 and 11.21 per 100 person-years, respectively; P=727) and death (2.28 and 1.79 per 100 person-years, respectively; P=277) were similar, with adjusted hazard ratios (aHRs) of 0.932 (P=0.622) and 0.667 (P=0.193), respectively. When stratified by treatment modality and the timing of antiviral therapy commencement, the values were similar (all P>0.05). Inverse probability of treatment weighting (IPTW) analyses yielded results that were similar in the two groups in terms of recurrence (aHR=1.038, P=0.963) and death (aHR=0.799, P=0.431). Furthermore, the early (<2 years) and late (≥2 years) recurrence risks were not statistically different in the two groups (both P=0.400), as confirmed by IPTW analysis (P=0.502 and P=0.377, respectively).

Conclusions: The prognoses in terms of recurrence and death after curative treatment of HBV-related HCC were not statistically different between the ETV and TDF groups. Further validation studies are needed.

Keywords: Curative; Entecavir; Hepatocellular carcinoma; Prognosis; Tenofovir; Treatment.

Copyright © 2021. Published by Elsevier B.V.

StephenW

恩替卡韦和替诺福韦在增强治疗乙型肝炎病毒相关肝细胞癌的预后方面的功效
李智贤1，朴京金2，秀英公园3，元英德3，俊勇公园2，杜英金2，桑勋安2，董贤信4，胜升金5
隶属关系
隶属关系

    1个
    延世大学医学院内科，韩国首尔。
    2个
    延世大学医学院内科，韩国首尔；延世大学医学院胃肠病研究所，韩国首尔；大韩民国首尔遣散医院延世肝脏中心。
    3
    韩国大邱庆北国立大学医院庆北国立大学医学院内科。
    4
    成均馆大学医学院三星医学中心内科，韩国首尔。电子地址：[email protected]。
    5
    延世大学医学院内科，韩国首尔；延世大学医学院胃肠病研究所，韩国首尔；大韩民国首尔遣散医院延世肝脏中心。电子地址：[email protected]。

    PMID：33810942 DOI：10.1016 / j.ejim.2021.02.019

抽象的

背景/目的：乙型肝炎病毒（HBV）相关的肝细胞癌（HCC）的治愈性治疗后，恩替卡韦（ETV）或替诺福韦地替莫韦富马酸酯（TDF）是否能提供更好的预后。我们比较了接受ETV的患者和接受TDF的患者的复发率和死亡率。

方法：在2013年至2017年期间，连续招募了三所机构接受过肝切除术（n = 421）或射频消融术（n = 305）作为一线抗HCC治疗的HBV相关HCC患者。所有患者均接受ETV或TDF作为一线抗病毒药物。评估了复发和死亡的累积概率。我们调整了病毒因素，包括HBV-DNA载量，肿瘤和人口统计学因素。

结果：在研究期间（中位数46.6 [四分位间距25.3-58.9]个月），有227例患者复发，其中53例死亡。在ETV（n = 405）和TDF（n = 321）组中，每年的复发率（分别为每100人年10.61和11.21； P = 727）和死亡（每100人年2.28和1.79），分别为P = 277），调整后的危险比（aHRs）分别为0.932（P = 0.622）和0.667（P = 0.193）。当按治疗方式和开始抗病毒治疗的时间分层时，这些值是相似的（所有P> 0.05）。治疗权重的逆概率（IPTW）分析得出的结果在两组（复发率（aHR = 1.038，P = 0.963）和死亡（aHR = 0.799，P = 0.431）方面相似。此外，IPTW分析证实，两组的早期（<2年）和晚期（≥2年）复发风险无统计学差异（均为P = 0.400）（分别为P = 0.502和P = 0.377）。

结论：ETV组和TDF组在HBV相关性HCC治愈性治疗后的复发和死亡预后方面无统计学差异。需要进一步的验证研究。

关键字：治愈；恩替卡韦;肝细胞癌；预后替诺福韦;治疗。

版权所有©2021，由Elsevier B.V.发布。