Comparative impact of antiviral therapies on postoperative recurrence risk in patients with hepatitis B virus-related hepatocellular carcinoma.

Background: Entecavir (ETV) and tenofovir fumarate (TDF) are recommended first-line agents for the treatment of chronic hepatitis B virus (HBV) infection. However, the effect of these 2 antiviral agents on the risk for recurrence of HBV-associated hepatocellular carcinoma (HCC) after radical hepatectomy remains controversial.

Aim: To compare the effect of TDF vs ETV on the risk for HCC recurrence after radical surgery for HBV-related HCC.

Methods: Data from consecutive patients, who received TDF or ETV after radical hepatectomy for HBV-related HCC and admitted to the Second Hospital of Longyan between December 2018 and December 2023, were retrospectively analyzed. Based on treatment method and propensity score matching (PSM), data from 100 patients were included, with 50 in each of the TDF and ETV groups, respectively. The baseline characteristics of the 2 groups were analyzed, and the risk for HCC recurrence was compared between the groups.

Results: The median follow-up for 100 patients [median age, 61 years; 84 male (84%)] who underwent radical resection for HBV-related HCC - Barcelona Clinic Liver Cancer stage 0 [n = 16 (16%)], stage A [n = 61 (61%)] - was 29 months (range, 12-60 months); the median tumor size was 3.0 cm (range, 2.1-4.3 cm). Sixty-eight (68%) patients exhibited HBV-DNA levels > 1000 IU/mL. Twenty-two (22%) patients tested positive for hepatitis B e antigen, in whom the HCC recurrence rate was 59.1% (13/22). After PSM, HCC recurrence rates in the ETV and TDF groups after hepatectomy were 66% (n = 33) and 42% (n = 21), respectively (P = 0.016), and cumulative recurrence rates at 1, 3, and 5 years were 26%, 58%, and 66%, and 18%, 38%, and 42%, respectively (P = 0.045).

Conclusion: TDF treatment is associated with a lower risk for HCC-related outcomes than that for ETV in patients with HBV-associated HCC after curative therapy.