Tenofovir vs. Entecavir on Recurrence of Hepatitis B Virus‐Related Hepatocellular Carcinoma after Surgical Resection

Studies have suggested that tenofovir disoproxil fumarate (TDF) treatment is associated with a significantly lower risk of hepatocellular carcinoma (HCC) occurrence when compared to entecavir (ETV) therapy in chronic hepatitis B patients. We aimed to compare HCC recurrence and survival of patients treated with TDF or ETV after surgical resection for hepatitis B virus (HBV)-related HCC. This historical cohort study included 1,695 consecutive patients treated with ETV (n=813) or TDF (n=882) after curative-intent hepatectomy for HBV-related HCC of Barcelona Clinic Liver Cancer stage 0 or A in Korea between 2010 and 2018. HCC recurrence and overall survival of patients were compared between ETV and TDF groups by propensity score-matched and multivariable-adjusted Cox regression analyses from the date of hepatectomy for HCC. Mean age of the study patients was 54.8 years and 1,294 patients (76.3%) were male. During median follow-up duration of 37.6 months with continued ETV or TDF therapy, 561 (33.1%) patients developed HCC recurrence, 144 (8.4%) died, and 22 (1.3%) received liver transplant. Compared with ETV, TDF therapy was associated with significantly higher recurrence-free (P=0.02) and overall survival (P=0.03) rates by propensity score-matched analysis. By multivariable-adjusted analysis, TDF group was associated with significantly lower rates of HCC recurrence (HR, 0.82; 95% CI, 0.68-0.98; P=0.03), and death or transplantation (HR, 0.62; 95% CI, 0.44-0.88; P=0.01). TDF therapy was an independent protective factor for both early (<2 years; HR, 0.79; P=0.03) and late (≥2 years; HR, 0.68; P=0.03) postoperative HCC recurrence. CONCLUSION: Among patients who underwent curative hepatectomy for HBV-related HCC, TDF therapy was associated with a significantly lower risk of HCC recurrence and better overall patient survival compared to ETV therapy.