Changes in antiviral treatment rate for hepatitis B virus before hepatocellular carcinoma diagnosis: a nationwide Korean study.

Background and aims: 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.

Methods: 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.

Results: 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).

Conclusion: 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.