Nucleos(t)ide Analogs Lower HCC Recurrence Risk in HBV Patients
SAN FRANCISCO, CA—Nucleos(t)ide analog (NA) treatment reduced the risk of hepatocellular carcinoma (HCC) recurrence and possibly death in patients with chronic hepatitis B virus (HBV) infection, particularly among those who received tumor resection and local ablative treatment for HCC, according to research presented at The Liver Meeting® 2015.
Oral nucleos(t)ide analogues have been shown to suppress HBV and reduce tumor recurrence and death in patients with HBV-related HCC.
Grace L.H. Wong, from the Chinese University of Hong Kong, Shatin, Hong Kong, and study investigators investigated the effects of NAs on clinical outcomes following different treatments for HCC. They conducted a territory-wide cohort study from the Hospital Authority database, "which provides medical services at both in-patient and out-patients settings for 70%–80% of Hong Kong citizens," she noted.
Patients with chronic HBV with HCC diagnosed between 2000–2012 were identified by ICD-9 diagnosis codes.
The primary outcome was HCC recurrence and death. The relative risk of primary outcome in patients with or without NA treatment was evaluated by a 3-month landmark analysis.
A total of 2,198 patients with chronic HBV (n=1,230 NA-untreated; n=968 NA-treated) with HCC who received at least one type of HCC treatment were included in the analysis. These treatments were tumor resection (n=810), local ablative therapy (LAT; n=1,015), transarterial chemoembolization (TACE; n=222), resection-LAT (n=73), and LAT-TACE (n=78).
Treatment with NA reduced the risk of overall HCC recurrence (adjusted sub-hazard ratio [SHR] 0.62, 95% CI: 0.49–0.80; P<0.001). The effect was most prominent in the subgroup of patients who underwent resection (SHR 0.58, 95% CI: 0.37–0.91; P=0.018) but "just fell short" in the LAT subgroup (SHR 0.68, 95% CI: 0.46–1.01; P=0.058) and was non-significant in TACE or combination subgroups, which ranged from SHR 0.47–0.90 (range, P=0.140–0.822).
The incidence rate of HCC recurrence was 10.7 in the NA-treated patients and 16.6 in those untreated; for death, these rates were 12.0 and 15.1, respectively.
Treatment with NA may reduce the risk of death; this was observed most prominently in the resection-LAT subgroup (HR 0.33, 95% CI: 0.10–1.11; P=0.030), they concluded.