Li Tao, Qu Yundong, Wang Yan, Lin Chunlei, Yang Baohua, Wang Lei
Department of Infectious Diseases and Hepatology, the Second Hospital of Shandong University, Jinan 250033, China.
J Coll Physicians Surg Pak. 2019 Apr;29(4):317-323. doi: 10.29271/jcpsp.2019.04.317.
To compare the reduction of hepatocellular carcinoma (HCC) risk between long-term treatment of entecavir and low genetic barrier antiviral agents in hepatitis B virus (HBV)-related cirrhotic patients.
An observational study.
Department of Infectious Diseases and Hepatology, the Second Hospital of Shandong University, Jinan, China, from October 2008 to October 2016.
HBV-related cirrhotic patients with antiviral treatment for at least 12 months were consecutively included. Propensity score matching analysis was performed to improve comparability of the data from both entecavir group and the control group. Log-rank test was used to compare influence of various nucleos(t)ide analogs (NAs) for incidence of HCC. Independent risk factors were estimated by multivariable Cox proportional hazards models.
The total cohort included 207 HBV-related cirrhotic patients, of which 83 patients were treated with entecavir initially. The present study found no statistical difference for the incidence of HCC between entecavir group and the control group in the total cohort (p=0.525). However, the difference became statistically significant (p=0.014) after propensity score matching. Number needed to treat (NNT) were 8 patients, 6 patients and 3 patients at years 2, 3 and 4, respectively. Multivariable Cox regression in propensity score matching cohort revealed older age (HR: 1.066, p=0.041), NAs of low generic barrier (HR: 6.944, p=0.016), NAs resistance (HR: 3.648, p=0.041), and lower platelet counts (<80x10 ⁹/L) (HR: 6.718, p=0.009) as independent risk factors for HCC incidence.
Entecavir is more efficient in reducing the incident HCC risk for HBV-related cirrhotic patients in comparison to low genetic barrier NAs.
比较恩替卡韦长期治疗与低基因屏障抗病毒药物在乙型肝炎病毒（HBV）相关肝硬化患者中降低肝细胞癌（HCC）风险的效果。
一项观察性研究。
2008年10月至2016年10月，中国济南山东大学齐鲁医院感染性疾病与肝病科。
连续纳入接受抗病毒治疗至少12个月的HBV相关肝硬化患者。进行倾向评分匹配分析以提高恩替卡韦组和对照组数据的可比性。采用对数秩检验比较各种核苷（酸）类似物（NAs）对HCC发生率的影响。通过多变量Cox比例风险模型估计独立危险因素。
总队列包括207例HBV相关肝硬化患者，其中83例患者最初接受恩替卡韦治疗。本研究发现，总队列中恩替卡韦组和对照组的HCC发生率无统计学差异（p = 0.525）。然而，倾向评分匹配后差异具有统计学意义（p = 0.014）。治疗所需人数（NNT）在第2年、第3年和第4年分别为8例、6例和3例。倾向评分匹配队列中的多变量Cox回归显示，年龄较大（HR：1.066，p = 0.041）、低基因屏障NAs（HR：6.944，p = 0.016）、NAs耐药（HR：3.648，p = 0.041）和血小板计数较低（<80×10⁹/L）（HR：6.718，p = 0.009）是HCC发生的独立危险因素。
与低基因屏障NAs相比，恩替卡韦在降低HBV相关肝硬化患者发生HCC风险方面更有效。
