Department of Hepatobiliary Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
BMC Cancer. 2019 May 29;19(1):511. doi: 10.1186/s12885-019-5735-9.
It has been proved that nucleos(t) ide analogues (NAs) therapy could improve underlying liver disease and reduce the incidence of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). However, the difference of effectiveness in reducing HCC occurrence between tenofovir (TDF) and enticavir (ETV), two first-line NAs drugs, is still little known. This meta analysis aims to assess the efficacy in reducing incidence of HCC comparing tenofovir monotherapy with entecavir monotherapy among chronic hepatitis B (CHB) patients by analyzing their long-term clinical outcomes.
Databases including PubMed, Embase, Cochrane Central Register of Controlled Trial, and ISI Web of Science were fully investigated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. For the included articles, two of the authors independently extracted and confirmed relevant data. Review Manager software (RevMan 5.3) was using for meta analysis.
Seven articles with 3698 patients were finally included in this research, 1574 in tenofovir group and 2124 in entecavir group. For meta analysis, the incidence of HCC was significantly lower among the tenofovir group than entecavir group [rate ratio (95% CI) of 0.66 (0.49, 0.89), P = 0.008], while there was no statistical significance in incidence of death or transplantation [rate ratio (95% CI) of 0.78 (0.55, 1.13), P = 0.19], encephalopathy [risk ratio (95% CI) of 0.72 (0.45, 1.13), P = 0.15] or variceal bleeding [risk ratio (95% CI) of 0.71 (0.34, 1.50), P = 0.37] between the two groups.
There is a better effect of tenofovir in reducing HCC incidence than entecavir, which indicates tenofovir should be used more widely while treating chronic hepatitis B patients. However before applying, randomized controlled trial and large prospective cohort study should be performed in the future.
核苷（酸）类似物（NAs）治疗已被证明可以改善基础肝病并降低乙型肝炎病毒（HBV）相关肝细胞癌（HCC）的发生率。然而，两种一线 NAs 药物替诺福韦（TDF）和恩替卡韦（ETV）在降低 HCC 发生方面的效果差异尚不清楚。本荟萃分析旨在通过分析长期临床结果，评估替诺福韦单药治疗与恩替卡韦单药治疗慢性乙型肝炎（CHB）患者在降低 HCC 发生率方面的疗效。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，全面检索 PubMed、Embase、Cochrane 中央对照试验注册库和 ISI Web of Science 数据库。对于纳入的文章，两位作者独立提取并确认了相关数据。使用 Review Manager 软件（RevMan 5.3）进行荟萃分析。
最终纳入了 7 篇文章，共 3698 例患者，替诺福韦组 1574 例，恩替卡韦组 2124 例。荟萃分析显示，替诺福韦组 HCC 发生率明显低于恩替卡韦组[比值比（95%可信区间）为 0.66（0.49, 0.89），P=0.008]，而死亡率或移植率[比值比（95%可信区间）为 0.78（0.55, 1.13），P=0.19]、脑病[风险比（95%可信区间）为 0.72（0.45, 1.13），P=0.15]或静脉曲张出血[风险比（95%可信区间）为 0.71（0.34, 1.50），P=0.37]无统计学意义。
替诺福韦在降低 HCC 发生率方面的效果优于恩替卡韦，这表明在治疗慢性乙型肝炎患者时应更广泛地使用替诺福韦。然而，在应用之前，未来应进行随机对照试验和大型前瞻性队列研究。
