Tenofovir vs Entecavir Among Patients With HBV-Related HCC After Resection

Abstract

ImportanceTenofovir disoproxil and entecavir are both commonly used first-line antiviral treatments, but their comparative recurrence and overall survival (OS) benefits remain unclear.ObjectiveTo explore differences of tenofovir disoproxil vs entecavir in recurrence-free survival (RFS) and OS after liver resection with curative intent in patients with hepatocellular cancer (HCC) related to hepatitis B virus (HBV).Design, Setting, and ParticipantsThis retrospective cohort study was conducted at Eastern Hepatobiliary Surgery Hospital, a tertiary referral hospital in Shanghai, China, between January 4, 2015, and April 1, 2023. Participants included patients with HBV-related HCC who underwent liver resection with curative intent from January 2015 to December 2018. Patients who received tenofovir disoproxil were matched with patients who received entecavir in a 1:1 ratio using propensity score matching. Data were analyzed from April 3 to May 31, 2023.ExposuresReceiving tenofovir disoproxil or entecavir as antiviral treatment for HBV.Main Outcomes and MeasuresPrimary end points were RFS and OS rates.ResultsAmong 4451 patients (mean [SD] age, 58.1 [10.0] years; 3764 male [84.6%]; median [range] follow-up, of 51 [3 to 91] months), 989 patients in each of the groups were selected in propensity score matching. Baseline characteristics were comparable. In propensity score–matched groups, OS rates were 92.2% at 1 year, 70.9% at 3 years, and 54.2% at 5 years in the entecavir group, compared with 90.9% at 1 year, 75.2% at 3 years, and 64.0% at 5 years in the tenofovir disoproxil group. RFS rates were 83.9% at 1 year, 50.0% at 3 years, and 43.3% at 5 years in the entecavir group, compared with 85.3% at 1 year, 55.6% at 3 years, and 51.4% at 5 years in the tenofovir disoproxil group. Patients in the tenofovir disoproxil group had better OS (hazard ratio, 0.82; 95% CI, 0.72 to 0.94; P = .004) and RFS rates (hazard ratio, 0.81; 95% CI, 0.72 to 0.92; P = .001) compared with the entecavir group. Restricted mean survival time differences of entecavir vs tenofovir disoproxil groups were −0.05 (95% CI, −0.18 to 0.08) months at 1 year (P = .45), 0.20 (95% CI, −0.62 to 1.03) months at 3 years (P = .63), and 1.82 (95% CI, 0.14 to 3.51) months at 5 years (P = .03).Conclusions and RelevanceThese findings suggest that in patients undergoing curative liver resection for HBV-related HCC, tenofovir disoproxil was associated with better long-term OS and RFS rates compared with entecavir, providing insights for antiviral treatment.

Preoperative Antiviral Therapy and Long-Term Outcomes for Hepatitis B Virus-Related Hepatocellular Carcinoma After Curative Liver Resection: A Multicenter Analysis

“… 30 Tenofovir disoproxil might be associated with better long-term OS and RFS rates compared with entecavir for HBV-related HCC patients undergoing curative liver resection. 31 Portal vein tumor thrombosis (PVTT) is an independent factor of 90-day mortality and long-term outcomes. 32 We excluded the HCC patients with PVTT due to the effect of preoperative antiviral therapy was easily overshadowed by the extremely high-risk factor.…”

Comment on “Change of indocyanine green clearance ability and liver function after transcatheter intraarterial therapies and its impact on outcomes of resectable hepatocellular carcinoma: a retrospective cohort study”

“…Furthermore, another study involving 4451 participants also found that the use of tenofovir disoproxil is associated with better overall survival and recurrence-free survival compared to entecavir therapy, highlighting the important role of antiviral treatment strategies in improving the prognosis of HCC patients. 3 However, information regarding antiviral treatment strategies for both groups of patients is missing in this study. In the absence of antiviral strategies, significant differences in patient prognosis may be due to different antiviral strategies rather than the effects of HAIC or TACE.…”