ABSTRACT
Objective:
To analyze the effect of nucleos(t)ide analog (NAs)
antiviral treatment on the clinical features and
prognosis of
patients with
hepatitis B virus-related
hepatocellular carcinoma (HBV-HCC).
Methods:
A retrospective
analysis was performed on the data of 450 HBV-HCC
patients first diagnosed and treated in the Third
Hospital of Hebei Medical
University from January 2015 to January 2021, including 193
patients in the continuous NAs
treatment group and 257
patients in the NAs
treatment after
hepatocellular carcinoma (HCC) group. The baseline data of the two groups were balanced by
propensity score matching. The
relapse-free
survival rate of HCC was estimated by Kaplan-Meier
method, and the
risk factors for HCC
recurrence were analyzed by Cox proportional
risk models. Spearman correlation
analysis was used to explore the
association between clinical features of HCC and
hepatitis B virus (HBV)
DNA load in
patients receiving continuous NAs
treatment.
Results:
Before matching, the proportions of
liver cirrhosis,
body mass index≥25.0 kg/m 2, single
tumor, maximum
tumor diameter ≤5 cm,
Child-Pugh grade A,
China liver cancer staging Ⅰ in the continuous NAs
treatment group were 93.8%(181/193), 45.1%(87/193), 70.5%(136/193), 82.4%(159/193), 74.6%(144/193) and 74.6%(144/193), respectively. All of them were higher than those in the NAs
treatment after HCC group (87.5%(225/257), 44.0%(113/257), 61.1%(157/257), 55.3%(142/257), 63.8%(164/257) and 56.0%(144/257), respectively). The proportions of
drinking history and
portal vein tumor thrombi in the continuous NAs
treatment group were 12.4%(24/193) and 3.1%(6/193), respectively, which were lower than 33.9%(87/257) and 10.5%(27/257) in the NAs
treatment after HCC group.The differences were all statistically significant ( χ2=4.86, 7.58, 4.27, 36.63, 8.15, 21.05, 27.21 and 8.88, respectively, all P<0.05). After matching, the median
relapse-free
survival time of the
patients in the continuous NAs
treatment group and the NAs
treatment after HCC group were 388 days and 277 days, respectively. The five-year cumulative
relapse-free
survival rates were 50.0% and 37.5%, respectively, with statistically significant difference ( χ2=5.30, P=0.021).
Multivariate analysis showed that no
antiviral therapy before
diagnosis of HCC, multiple
tumors, maximum
tumor diameter ≥5 cm and
palliative treatment were independent
risk factors for HBV-HCC
recurrence (
hazard ratio ( HR)=1.509, 1.491, 0.446 and 1.472, respectively, all P<0.05). After matching, the maximum
tumor diameter ( r=0.175, P=0.042),
incidence of
portal vein tumor thrombi ( r=0.210, P=0.014) and
recurrence of HBV-HCC ( r=0.178, P=0.038) in the continuous NAs
treatment group were positively correlated with HBV
DNA load.
Conclusions:
Early initiation of NAs
antiviral treatment can improve the
tumor characteristics when the
disease progresses to HBV-HCC, and improve the
relapse-free
survival rate of HBV-HCC
patients. No
antiviral therapy before
diagnosis of HCC, multiple
tumors, maximum
tumor diameter ≥5 cm and
palliative treatment are independent
risk factors for HBV-HCC
recurrence.