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Effect of Nucleos(t)ide Analogs on Patients with Intermediate and Advanced Hepatitis B Virus-Related Hepatocellular Carcinoma

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Abstract

Background

The role of nucleos(t)ide analogs (NAs) therapy in intermediate and advanced hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unclear.

Aims

The aim was to evaluate the effect of NAs therapy on survival of intermediate- and advanced-stage HBV-related HCC patients initially treated with chemoembolization.

Methods

A total of 1016 Barcelona Clinic Liver Cancer (BCLC) stage B/C HBV-related HCC patients initially treated with chemoembolization were included. Propensity score matching (PSM) was performed to decrease heterogeneity between the antiviral and non-antiviral groups. Kaplan–Meier and Cox regression analysis were performed to evaluate the effects of NAs therapy on overall survival (OS).

Results

Antiviral group (n = 394) significantly prolonged OS compared with non-antiviral group (n = 622) (p = 0.003). NAs therapy (p < 0.001) along with tumor size (p = 0.002), tumor number (p = 0.001), gross vascular invasion (p < 0.001), metastasis (p < 0.001), α-fetoprotein (p < 0.001), Child–Pugh score (p = 0.008), aspartate aminotransferase (p < 0.001), and HBV DNA (p = 0.018) were identified as independent prognostic factors for OS. After PSM processing, deducting the influence of subsequent treatments for HCC, NAs therapy was still identified as an independent protective factor (p = 0.009) for OS in patients who survived ≥ 7 months, regardless of BCLC stage B or C HCC.

Conclusion

NAs therapy prolongs OS in intermediate- and advanced-stage HBV-related HCC patients initially treated with chemoembolization. After PSM processing, patients who survived ≥ 7 months still benefited from NAs therapy.

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Funding

This work was partly supported by project grants from the National Natural Science Foundation of China (No. 81773057).

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Author notes

  1. Zhi-Wei Jian, Xi-Wen Wu, and Zhen-Xin Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People’s Republic of China

    Zhi-Wei Jian, Xi-Wen Wu, Zhen-Xin Chen, Jun-Cheng Wang, Jing-Yuan Peng & Xiang-Ming Lao

  2. State Key Laboratory of Oncology in South China, Guangzhou, 510060, Guangdong, People’s Republic of China

    Zhi-Wei Jian, Xi-Wen Wu, Zhen-Xin Chen, Jun-Cheng Wang, Jing-Yuan Peng & Xiang-Ming Lao

  3. Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People’s Republic of China

    Zhi-Wei Jian, Xi-Wen Wu, Zhen-Xin Chen, Jun-Cheng Wang, Jing-Yuan Peng & Xiang-Ming Lao

  4. Department of Hepatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, People’s Republic of China

    Xi-Wen Wu

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Contributions

XML is the correspondent author of this article and also acting as the submission’s guarantor. ZWJ, XWW, and ZXC have equally contributed to this article as first authors. XML conceived and designed the study. ZWJ, XWW, ZXC, JCW, and JYP collected and analyzed the data. ZWJ, XWW, ZXC, and XML interpreted the data. ZWJ, XWW, ZXC, and XML drafted or wrote the manuscript. XML obtained funding. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Xiang-Ming Lao.

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Jian, ZW., Wu, XW., Chen, ZX. et al. Effect of Nucleos(t)ide Analogs on Patients with Intermediate and Advanced Hepatitis B Virus-Related Hepatocellular Carcinoma. Dig Dis Sci 64, 2187–2198 (2019). https://doi.org/10.1007/s10620-019-05543-4

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