COMPARISON OF THE OCCURRENCE OF HEPATOCELLULAR CARCINOMA IN PATIENTS OF CHRONIC HEPATITIS B WITH ENTECAVIR AND TENOFOVIR: A META-ANALYSIS OF KOREAN DATA

초록

Background: In chronic hepatitis B (CHB), nucleos(t)ide analogues (NAs) cannot exterminate the virus, and only suppress its proliferation. Thus, even though NAs improve the liver function, the risk of hepatocellular carcinoma (HCC) persists over time. Since a large cohort study which suggested the superiority of tenofovir over entecavir in reducing HCC risk, there is a great deal of controversy in choosing NAs. In this study, we aimed to meta-analyze the published data from Korea to date together with the unpublished data of our institution to derive the robust conclusion. Methods: We searched on-line database and derived 6 publications from Korea. In addition, we investigated 535 treatment-naïve patients with CHB who were first treated with entecavir (n=298) and tenofovir (n=237) between 2008 and 2016 at Korea University Medical Center (Ansan and Guro Hospitals). We used Kaplan-Meier method, Cox regression model, propensity score matching and meta-analysis. Results: From the 6 publications, 9,844 patients were included, 556 developed HCC. From our institutions, HCC was developed in 59 patients during a median follow-up of 21.6 months. After 1:1 propensity score matching, the kind of antiviral agent did not affect the development of HCC (HR, 0.72; 95% CI 0.31-1.71; P=0.46). Combined with the results of six domestic studies, the tenofovir group did not show significant suppression of HCC development compared to the entecavir group (HR, 0.96; 95% CI 0.74-1.25). Conclusion: In a meta-analysis of seven studies of HBV-endemic area including our own institutional data, HCC occurrence was not significantly different between patients with treated with entecavir or tenofovir.