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恩替卡韦与替诺福韦对肝癌根治性切除术后乙型肝炎病毒相关肝细胞癌预后的影响。

Entecavir versus tenofovir on prognosis of hepatitis B virus-related hepatocellular carcinoma after curative hepatectomy.

机构信息

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

出版信息

Aliment Pharmacol Ther. 2023 Jun;57(11):1299-1312. doi: 10.1111/apt.17438. Epub 2023 Mar 13.

Abstract

BACKGROUND

There is still controversy about whether tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have different effects on the outcomes of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).

AIMS

The aim of this study was to compare the prognoses between ETV and TDF treatment among patients with HBV-related HCC after hepatectomy.

METHODS

An analysis was done on data from the Taiwan Cancer Registry, which was linked to Taiwan National Health Insurance Research Database, for the years 2011-2016. We identified 7107 patients with HBV-related HCC after curative hepatectomy, and 25.3% of them used ETV or TDF after surgery. After propensity score overlap weighting, 1797 patients treated with ETV (n = 1365) or TDF (n = 432) were included for analyses. Cox proportional hazards models were used to compare the efficacy of ETV and TDF for recurrence and overall survival (OS).

RESULTS

After hepatectomy, the recurrence rate per 100 person-years was 14.87 for the ETV group and 9.25 for the TDF group. The risk of recurrence was similar in the TDF group and the ETV group (HR [95% CI]: 0.91 [0.69-1.19; p = 0.479]), as was the risk of all-cause mortality (HR [95% CI]: 0.67 [0.42-1.07]; p = 0.091). When considering early recurrence (<2 years) and late recurrence (≧2 years), the TDF and ETV groups showed no significant differences. Subgroup analyses and sensitivity analyses demonstrated consistent results.

CONCLUSION

Both TDF and ETV showed similar health benefits in terms of recurrence and OS in patients with HBV-related HCC patients after hepatectomy.

摘要

背景

关于替诺福韦酯二吡呋酯(TDF)和恩替卡韦(ETV)是否对乙型肝炎病毒(HBV)相关肝细胞癌(HCC)患者的结局有不同影响,仍存在争议。

目的

本研究旨在比较 TDF 和 ETV 治疗乙型肝炎病毒相关 HCC 患者肝切除术后的预后。

方法

对 2011 年至 2016 年台湾癌症登记处与台湾全民健康保险研究数据库链接的数据进行了分析。我们共鉴定了 7107 例乙型肝炎病毒相关 HCC 患者,术后 25.3%的患者使用 ETV 或 TDF。在倾向评分重叠加权后,纳入 1797 例接受 ETV(n=1365)或 TDF(n=432)治疗的患者进行分析。采用 Cox 比例风险模型比较 ETV 和 TDF 对复发和总生存(OS)的疗效。

结果

肝切除术后,ETV 组和 TDF 组的每 100 人年复发率分别为 14.87 和 9.25。TDF 组和 ETV 组的复发风险相似(HR[95%CI]:0.91[0.69-1.19;p=0.479]),全因死亡率的风险也相似(HR[95%CI]:0.67[0.42-1.07;p=0.091)。考虑早期复发(<2 年)和晚期复发(≧2 年)时,TDF 组和 ETV 组无显著差异。亚组分析和敏感性分析得出了一致的结果。

结论

在乙型肝炎病毒相关 HCC 患者肝切除术后,TDF 和 ETV 在复发和 OS 方面均显示出相似的健康获益。

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