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. 2023 Oct 2;6(10):e2340353.
doi: 10.1001/jamanetworkopen.2023.40353.

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

Pengpeng Li  1 , Yuanyuan Wang  1 , Jian Yu  1 , Judian Yu  1 , Qifei Tao  1 , Jinwei Zhang  1 , Wan Yee Lau  2 , Weiping Zhou  1 , Gang Huang  1
Affiliations

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

Pengpeng Li et al. JAMA Netw Open. .

Abstract

Importance: Tenofovir disoproxil and entecavir are both commonly used first-line antiviral treatments, but their comparative recurrence and overall survival (OS) benefits remain unclear.

Objective: To 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 participants: This 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.

Exposures: Receiving tenofovir disoproxil or entecavir as antiviral treatment for HBV.

Main outcomes and measures: Primary end points were RFS and OS rates.

Results: Among 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 relevance: These 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.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flowchart of Patient Selection
ETV indicates entecavir; HBV, hepatitis B virus; HCC, hepatocellular cancer; and TDF, tenofovir disoproxil.
Figure 2.
Figure 2.. Overall Survival and Recurrence-Free Survival in the Propensity Score–Matched Cohort
ETV indicates entecavir; HR, hazard ratio; and TDF, tenofovir disoproxil.
Figure 3.
Figure 3.. Restricted Mean Survival Times (RMST) in the Propensity Score–Matched Cohort
ETV indicates entecavir; TDF, tenofovir disoproxil.
See this image and copyright information in PMC

References

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