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Multicenter Study
. 2018 Jul;48(1):44-54.
doi: 10.1111/apt.14801. Epub 2018 May 24.

Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience

V L Chen  1   2 , M-L Yeh  3 , A K Le  4 , M Jun  5 , W K Saeed  6 , J D Yang  7 , C-F Huang  3 , H Y Lee  6 , P-C Tsai  3 , M-H Lee  8 , N Giama  7 , N G Kim  9 , P P Nguyen  4 , H Dang  4 , H A Ali  7 , N Zhang  7 , J-F Huang  3 , C-Y Dai  3 , W-L Chuang  3 , L R Roberts  7 , D W Jun  6 , Y-S Lim  5 , M-L Yu  3 , M H Nguyen  4
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Free article
Multicenter Study

Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience

V L Chen et al. Aliment Pharmacol Ther. 2018 Jul.
Free article

Abstract

Background: Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis.

Methods: This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death.

Results: Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001).

Conclusions: Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.

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