Effect of nucleos(t)ide analogue therapy on hepatocarcinogenesis in chronic hepatitis B patients: A propensity score analysis

• Published in: Journal of hepatology 2013-03, Vol.58 (3), p.427-433
• Main Authors: Kumada, Takashi, Toyoda, Hidenori, Tada, Toshifumi, Kiriyama, Seiki, Tanikawa, Makoto, Hisanaga, Yasuhiro, Kanamori, Akira, Niinomi, Takurou, Yasuda, Satoshi, Andou, Yusuke, Yamamoto, Kenta, Tanaka, Junko
• Format: Article
• Language: English
• Subjects: Adenine - analogs & derivatives; Adenine - therapeutic use; Adolescent; Adult; Aged; Aged, 80 and over; alpha-Fetoproteins - analysis; Antiviral Agents - therapeutic use; Average integration value; BCP; Child; Child, Preschool; Female; Follow-Up Studies; Gamma-GTP; Gastroenterology and Hepatology; Guanine - analogs & derivatives; Guanine - therapeutic use; HBcrAg; HBV DNA; Hepatitis B Core Antigens - blood; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; Humans; Incidence; Lamivudine - therapeutic use; Liver Neoplasms - epidemiology; Liver Neoplasms - prevention & control; Male; Middle Aged; Organophosphonates - therapeutic use; Proportional Hazards Models
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2012.10.025

Background & Aims Some patients with chronic hepatitis B virus (HBV) infection progress to hepatocellular carcinoma (HCC). However, the long-term effect of nucleos(t)ide analogue (NA) therapy on progression to HCC is unclear. Methods Therefore, we compared chronic hepatitis B patients who received NA therapy to those who did not, using a propensity analysis. Results Of 785 consecutive HBV carriers between 1998 and 2008, 117 patients who received NA therapy and 117 patients who did not, were selected by eligibility criteria and propensity score matching. Factors associated with the development of HCC were analyzed. In the follow-up period, HCC developed in 57 of 234 patients (24.4%). Factors significantly associated with the incidence of HCC, as determined by Cox proportional hazards models, include higher age (hazard ratio, 4.36 [95% confidence interval, 1.33–14.29], p = 0.015), NA treatment (0.28 [0.13–0.62], p = 0.002), basal core promoter (BCP) mutations (12.74 [1.74–93.11], p = 0.012), high HBV core-related antigen (HBcrAg) (2.77 [1.07–7.17], p = 0.036), and high gamma glutamyl transpeptidase levels (2.76 [1.49–5.12], p = 0.001). Conclusions NA therapy reduced the risk of HCC compared with untreated controls. Higher serum levels of HBcrAg and BCP mutations are associated with progression to HCC, independent of NA therapy.