Extrahepatic Malignancies and Antiviral Drugs for Chronic Hepatitis B: A Nationwide Cohort Study

医学 恩替卡韦 内科学 危险系数 队列 倾向得分匹配 置信区间 入射(几何) 比例危险模型 恶性肿瘤 混淆 慢性肝炎 胃肠病学 免疫学 拉米夫定 病毒 物理 光学
作者
Moon Haeng Hur,Dong Hyeon Lee,Jeong Hoon Lee,Misook Kim,Jeayeon Park,Hyun‐Jae Shin,Sung Won Chung,Hee Jin Cho,Min Kyung Park,Heejoon Jang,Yun Bin Lee,Su Jong Yu,Sang Hyub Lee,Yong Jin Jung,Yoon Jun Kim,Jung‐Hwan Yoon
出处
期刊:Clinical and molecular hepatology [Korean Association for the Study of the Liver]
标识
DOI:10.3350/cmh.2024.0055
摘要

Background/Aims: Chronic hepatitis B (CHB) is related to an increased risk of extrahepatic malignancy (EHM), and antiviral treatment is associated with an incidence of EHM comparable to controls.We compared the risks of EHM and intrahepatic malignancy (IHM) between entecavir (ETV) and tenofovir disoproxil fumarate (TDF) treatment. Methods:Using data from the National Health Insurance Service of Korea, this nationwide cohort study included treatment-naïve CHB patients who initiated ETV (n=24,287) or TDF (n=29,199) therapy between 2012 and 2014.The primary outcome was the development of any primary EHM.Secondary outcomes included overall IHM development.E-value was calculated to assess the robustness of results to unmeasured confounders. Results:The median follow-up duration was 5.9 years, and all baseline characteristics were well balanced after propensity score matching.EHM incidence rate differed significantly between within versus beyond 3 years in both groups (P<0.1,Davies test).During the first 3 years, EHM risk was comparable in the propensity score-matched cohort (5.88 versus 5.84/1,000 person-years; subdistribution hazard ratio [SHR]=1.01,95% confidence interval[CI]=0.88-1.17,P=0.84).After year 3, however, TDF was associated with a significantly lower EHM incidence compared to ETV (4.92 versus 6.91/1,000 person-years; SHR=0.70,95% CI=0.60-0.81,P<0.01; E-value for SHR=2.21).Regarding IHM, the superiority of TDF over ETV was maintained both within (17.58 versus 20.19/1,000 person-years; SHR=0.88,95% CI=0.81-0.95,P<0.01) and after year 3 (11.45versus 16.20/1,000 person-years; SHR=0.68,95% CI=0.62-0.75,P<0.01; E-value for SHR=2.30).Conclusions: TDF was associated with approximately 30% lower risks of both EHM and IHM than ETV in CHB patients after 3 years of antiviral therapy.
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