Chon Young Eun, Lee Jonghyun, Yoon Eileen L, Kim Soon Sun, Ahn Sang Bong, Jeong Soung Won, Jun Dae Won
Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam.
Department of Medical and Digital Engineering, Hanyang University College of Engineering, Seoul.
Eur J Gastroenterol Hepatol. 2025 Oct 1;37(10):1166-1172. doi: 10.1097/MEG.0000000000003000. Epub 2025 Aug 27.
Antiviral treatment (AVT) reduces hepatitis B virus (HBV) reactivation and hepatocsellular carcinoma (HCC) development; however, the impact of AVT timing - before versus after HCC diagnosis - on prognosis remains unclear. This study aimed to evaluate the current status, changes, and clinical outcomes of AVT before HCC diagnosis in Korea.
Data were extracted from the Korean National Health Insurance Service for patients newly diagnosed with HBV-related HCC from 2008 to 2018. Patients were categorized into an early cohort (2008-2013) and a late cohort (2014-2018). AVT trends were analyzed using Joinpoint regression, and clinical outcomes were compared between groups.
Among 82 609 patients (early cohort: n = 45 804; late cohort: n = 36 805), the proportion receiving AVT before HCC diagnosis increased from 22.4% in 2008 to 46.8% in 2018. AVT after diagnosis also rose from 16.3 to 21.3%. Overall survival rates in the late cohort were significantly improved compared with the early cohort (P < 0.001). More than half of the patients with HCC who received transplantation or local ablation treatment had received AVT before HCC diagnosis. AVT before HCC diagnosis was associated with reduced mortality rate (adjusted hazard ratio = 0.592; 95% confidence interval: 0.580-0.604; P < 0.001). Elderly patients (≥80 years) consistently had a lower AVT rate before HCC diagnosis compared with other age groups (P < 0.05).
The AVT rate before HCC diagnosis significantly increased over the past 10 years in Korea. Further efforts are needed to improve the AVT rate in elderly patients with HBV-related HCC.
抗病毒治疗（AVT）可降低乙型肝炎病毒（HBV）再激活及肝细胞癌（HCC）的发生风险；然而，AVT时机（HCC诊断之前与之后）对预后的影响仍不明确。本研究旨在评估韩国HCC诊断之前AVT的现状、变化及临床结局。
从韩国国民健康保险服务中心提取2008年至2018年新诊断为HBV相关HCC患者的数据。患者分为早期队列（2008 - 2013年）和晚期队列（2014 - 2018年）。使用Joinpoint回归分析AVT趋势，并比较组间临床结局。
在82609例患者中（早期队列：n = 45804；晚期队列：n = 36805），HCC诊断之前接受AVT的比例从2008年的22.4%增至2018年的46.8%。诊断后接受AVT的比例也从16.3%升至21.3%。晚期队列的总生存率与早期队列相比显著提高（P < 0.001）。接受移植或局部消融治疗的HCC患者中，超过半数在HCC诊断之前接受了AVT。HCC诊断之前接受AVT与死亡率降低相关（调整后风险比 = 0.592；95%置信区间：0.580 - 0.604；P < 0.001）。与其他年龄组相比，老年患者（≥80岁）在HCC诊断之前的AVT率始终较低（P < 0.05）。
在过去10年中，韩国HCC诊断之前的AVT率显著上升。需要进一步努力提高HBV相关HCC老年患者的AVT率。
