Cho H, et al. - Researchers, in this study, evaluated if high-potency nucleos(t)ide analogues (NAs) (entecavir and tenofovir disoproxil fumarate [TDF]) reduced the risk of tumor recurrence more potently than low-potency NAs after curative treatment of hepatitis B virus (HBV)-related HCC. Compared with other antivirals and no antiviral treatment, antiviral agents with high genetic barrier to resistance (entecavir and TDF) reduced the risk of HCC recurrence. This was particularly evident in patients with high baseline viral load.

Methods

• Six hundred seven consecutive HBV-related HCC patients treated with surgical resection or radiofrequency ablation were included.
• According to antiviral treatment, the patients were categorized into three groups: group A (no antiviral; n=261), group B (low-potency NA; n=90), and group C (high-potency NA; n=256).
• Recurrence-free survival (RFS) was the primary endpoint of this study.

Results

• In groups A, B, and C, the median RFS was 29.4, 25.1, and 88.2 months, respectively (P<0.001, log-rank test) during the duration of follow-up.
• In multivariate Cox analysis, group C showed a significantly longer RFS than both group A (adjusted hazard ratio [HR]=0.39, P<0.001) and group B (adjusted HR=0.47, P<0.001).
• Group C had a significantly longer RFS than group A (adjusted HR=0.46, P<0.001) and group B (adjusted HR=0.59, P=0.007) even when baseline characteristics were balanced using inverse probability weighting.
• Significantly lower risk of viral breakthrough was observed in group C compared to group B (HR=0.19, P<0.001). 
• Among groups B and C, viral breakthrough demonstrated to be an independent risk factor for shorter RFS (adjusted HR=2.03, P=0.007, time-dependent Cox analysis).