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; < .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; < .001) than 2 years before (aHR, 0.88; = .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.

中文翻译：

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对于乙型肝炎病毒相关的肝细胞癌，替诺福韦比恩替卡韦具有更好的预后


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）是否具有不同的作用仍存在争议。本研究旨在比较慢性乙型肝炎患者中替诺福韦和恩替卡韦的 HCC 长期预后。2008 年 11 月至 2018 年 12 月期间诊断为 HCC 并在韩国三级中心接受恩替卡韦或替诺福韦治疗的慢性乙型肝炎患者包括。使用多变量调整的 Cox 和倾向评分 (PS) 匹配分析评估替诺福韦与恩替卡韦对 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 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（调整后的风险比 [aHR]，0.79；< .001），这在 PS 匹配分析中得到了一致观察。诊断 HCC 后 2 年 (aHR, 0.50; < .001) 的 OS 风险差异程度比 2 年前 (aHR, 0.88; = .005) 更为显着，并且在患有以下疾病的患者中更为明显： HCC 早期阶段。在所有亚组中，除了预期寿命较短的患者（例如肝功能受损的患者）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，尤其是那些生存期较长的患者。