Chung Sung Won, Um Hyun Jun, Choi Won-Mook, Choi Jonggi, Lee Danbi, Shim Ju Hyun, Kim Kang Mo, Lim Young-Suk, Lee Han Chu
Liver Center, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Liver Center, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clin Gastroenterol Hepatol. 2025 Feb;23(2):300-309.e9. doi: 10.1016/j.cgh.2024.07.013. Epub 2024 Jul 31.
Whether tenofovir or entecavir has different effects on the prevention of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in secondary and tertiary preventive settings is still a matter of debate. This study aimed to compare the long-term prognosis of HCC between tenofovir and entecavir in patients with chronic hepatitis B.
Chronic hepatitis B patients diagnosed with HCC between November 2008 and December 2018 and treated with either entecavir or tenofovir at a tertiary center in Korea were included. The effect of tenofovir compared with entecavir on the prognosis of HBV-related HCC was assessed using multivariable-adjusted Cox and propensity score (PS)-matched analyses. Various predefined subgroup analyses were conducted.
During a median follow-up period of 3.0 years, the mortality rate for entecavir-treated patients (n = 3469) was 41.2%, while tenofovir-treated patients (n = 3056) had a mortality rate of 34.6%. Overall survival (OS) was better in the tenofovir group (adjusted hazard ratio [aHR], 0.79; P < .001), which were consistently observed in the PS-matched analysis. The magnitude of the risk difference in OS was more prominent 2 years after the diagnosis of HCC (aHR, 0.50; P < .001) than 2 years before (aHR, 0.88; P = .005), and it was more pronounced in patients with earlier HCC stages. In all subgroups, except for those with shorter life expectancy, such as those with compromised liver function, tenofovir was associated with better OS compared with entecavir.
Among patients with HBV-related HCC, those treated with tenofovir had a better prognosis than those treated with entecavir, particularly among those with prolonged survival.
在二级和三级预防环境中，替诺福韦或恩替卡韦对预防乙型肝炎病毒（HBV）相关肝细胞癌（HCC）是否具有不同效果仍存在争议。本研究旨在比较替诺福韦和恩替卡韦在慢性乙型肝炎患者中HCC的长期预后。
纳入2008年11月至2018年12月期间在韩国一家三级中心被诊断为HCC并接受恩替卡韦或替诺福韦治疗的慢性乙型肝炎患者。使用多变量调整的Cox分析和倾向评分（PS）匹配分析评估替诺福韦与恩替卡韦相比对HBV相关HCC预后的影响。进行了各种预定义的亚组分析。
在中位随访期3.0年期间，恩替卡韦治疗患者（n = 3469）的死亡率为41.2%，而替诺福韦治疗患者（n = 3056）的死亡率为34.6%。替诺福韦组的总生存期（OS）更好（调整后风险比[aHR]，0.79；P <.001），这在PS匹配分析中一致观察到。HCC诊断后2年时OS的风险差异幅度（aHR，0.50；P <.001）比诊断前2年（aHR，0.88；P =.005）更显著，并且在HCC早期阶段的患者中更明显。在所有亚组中，除了那些预期寿命较短的患者，如肝功能受损患者外，与恩替卡韦相比，替诺福韦与更好的OS相关。
在HBV相关HCC患者中，接受替诺福韦治疗的患者比接受恩替卡韦治疗的患者预后更好，特别是在那些生存期延长的患者中。
