作者
Daniel Q. Huang,Joseph Hoang,Rubayet Kamal,Pei‐Chien Tsai,Hidenori Toyoda,Ming‐Lun Yeh,Satoshi Yasuda,Jennifer Leong,Mayumi Maeda,Chung‐Feng Huang,Dae Won Jun,Masatoshi Ishigami,Yasuhito Tanaka,Haruki Uojima,Eiichi Ogawa,Hiroshi Abe,Yao‐Chun Hsu,Cheng‐Hao Tseng,Manaf Alsudaney,Ju Dong Yang,Yoko Yoshimaru,Takanori Suzuki,Joanne K. Liu,Charles Landis,Chia‐Yen Dai,Jee‐Fu Huang,Wan‐Long Chuang,Myron Schwartz,Yock Young Dan,Carlos O. Esquivel,Andrew Bonham,Ming‐Lung Yu,Mindie H. Nguyen
摘要
PURPOSE There are limited data on antiviral treatment utilization and its impact on long-term outcomes of hepatitis B virus (HBV)– and hepatitis C virus (HCV)–related hepatocellular carcinoma (HCC) after hepatic resection. We aimed to determine the utilization and impact of antivirals in HBV- and HCV-related HCC. METHODS This cohort study included 1,906 participants (1,054 HBV-related HCC and 852 HCV-related HCC) from 12 international sites. All participants had HBV- or HCV-related HCC and underwent curative surgical resection. The primary outcome was the utilization of antiviral therapy, and the secondary outcome was long-term overall survival (OS). RESULTS The mean (±standard deviation [SD]) age was 62.1 (±11.3) years, 74% were male, and 84% were Asian. A total of 47% of the total cohort received antiviral therapy during a mean (±SD) follow-up of 5.0 (±4.3) years. The overall antiviral utilization for participants with HBV-related HCC was 57% and declined over time, from 65% before 2010, to 60% from 2010 to 2015, to 47% beyond 2015, P < .0001. The overall utilization of antivirals for HCV-related HCC was 35% and increased over time, from 24% before 2015 to 74% from 2015 and beyond, P < .0001. The 10-year OS was lower in untreated participants for both HBV (58% v 61%) and HCV participants (38% v 82%; both P < .0001). On multivariable Cox regression analysis adjusted for relevant confounders, antiviral therapy initiated before or within 6 months of HCC diagnosis was independently associated with lower mortality in both HBV- (adjusted hazard ratio [aHR], 0.60 [95% CI, 0.43 to 0.83]; P = .002) and HCV-related HCC (aHR, 0.18 [95% CI, 0.11 to 0.31]; P < .0001). CONCLUSION Antiviral therapy is associated with long-term survival in people with HBV- or HCV-related HCC who undergo curative resection but is severely underutilized.