Tenofovir Is Associated With Lower Risk of Hepatocellular Carcinoma Than Entecavir in Patients With Chronic HBV Infection in China
Tenofovir Is Associated With Lower Risk of Hepatocellular Carcinoma Than Entecavir in Patients With Chronic HBV Infection in China
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DOI：
10.1053/j.gastro.2019.09.025
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发表时间：
2020-01-01
期刊：
影响因子：
29.4
通讯作者：
Wong, Grace Lai-Hung
中科院分区：
文献类型：
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作者：
Yip, Terry Cheuk-Fung;Wong, Vincent Wai-Sun;Wong, Grace Lai-Hung
背景与目的：比较富马酸替诺福韦酯（TDF）与恩替卡韦治疗的慢性B肝炎病毒（HBV）感染患者发生肝细胞癌（HCC）风险的研究结果存在矛盾。我们比较了TDF与恩替卡韦在中国慢性HBV感染患者中对HCC风险的影响。方法：我们对2008年1月至2018年6月期间连续接受恩替卡韦或TDF治疗至少6个月的慢性HBV感染成人进行了回顾性研究。在治疗前或治疗前6个月内患有癌症或肝移植的患者被排除在外。采用倾向评分加权和1：5匹配来平衡2组之间的临床特征。Fine-Gray模型用于调整死亡和肝移植的竞争风险。研究结果：我们分析了29,350例患者的数据（平均年龄52.9 ± 13.2岁; 18,685例男性[63.7%]）; 1309例首次接受TDF治疗（4.5%），28,041例首次接受恩替卡韦治疗（95.5%）。TDP治疗的患者更年轻（平均年龄43.2岁vs 53.4岁），肝硬化比例更低（38例患者[2.9%] vs恩替卡韦治疗的3822例患者[13.6%]）。在治疗开始后的中位随访时间为3.6年（四分位距，1.7-5.0年），8名TDF治疗的患者（0.6%）和1386名恩替卡韦治疗的患者（4.9%）发生了HCC。倾向评分加权后，患者的临床特征具有可比性。在倾向评分加权（加权子分布风险比，0.36; 95%置信区间0.16-0.80; P = 0.013）和1：5匹配（加权子分布风险比，0.39; 95%置信区间0.18-0.84; P = 0.016）后，TDF治疗与较低的HCC风险相关。结论：在一项对中国29，350例慢性HBV感染患者的回顾性分析中，TDF治疗比恩替卡韦治疗的HCC风险低，平均随访时间为3.6年。
BACKGROUND & AIMS: There have been conflicting results from studies comparing the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection treated with tenofovir disoproxil fumarate (TDF) vs those treated with entecavir. We compared the effects of TDF vs entecavir on HCC risk in a large cohort of patients with chronic HBV infection in China. METHODS: We performed a retrospective study of consecutive adults with chronic HBV infection who initially received treatment with entecavir or TDF, for at least 6 months, from January 2008 through June 2018. Patients who had cancers or liver transplantation before or within the first 6 months of treatment were excluded. Propensity score weighting and 1:5 matching were used to balance the clinical characteristics between the 2 groups. Fine-Gray model was used to adjust for competing risk of death and liver transplantation. RESULTS: We analyzed data from 29,350 patients (mean age, 52.9 +/- 13.2 years; 18,685 men [63.7%]); 1309 were first treated with TDF (4.5%) and 28,041 were first treated with entecavir (95.5%). TDF-treated patients were younger (mean age, 43.2 years vs 53.4 years) and a lower proportion had cirrhosis (38 patients [2.9%] vs 3822 patients treated with entecavir [13.6%]). At a median follow-up time of 3.6 years after treatment began (interquartile range, 1.7-5.0 years), 8 TDF-treated patients (0.6%) and 1386 entecavir-treated patients (4.9%) developed HCC. Patients' clinical characteristics were comparable after propensity score weighting. TDF treatment was associated with a lower risk of HCC than entecavir treatment after propensity score weighting (weighted subdistribution hazard ratio, 0.36; 95% confidence interval 0.16-0.80; P = .013) and 1:5 matching (weighted subdistribution hazard ratio, 0.39; 95% confidence interval 0.18-0.84; P = .016). CONCLUSIONS: In a retrospective analysis of 29,350 patients with chronic HBV infection in China, treatment with TDF was associated with a lower risk of HCC than treatmentwith entecavir, over amedian follow-up time of 3.6 years.