Background: Our study aimed to explore whether hepatitis B surface antigen (HBsAg) levels affected the role of nucleot(s)ide analog treatment (entecavir (ETV) and tenofovir (TDF)) in improving the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients after liver resection.
Methods: A total of 865 HBV-related HCC patients after hepatectomy treated with TDF or ETV were included in our study. Patients were divided into the high HBsAg cohort (n=681) and the low HBsAg cohort (n=184). Propensity score matching (PSM) analysis was used to reduce the impact of potential confounding factors. Kaplan-Meier method and competing risk analysis were used to compare the survival outcomes.
Results: In the High HBsAg cohort, patients in the TDF group had better recurrence-free survival (RFS) and overall survival (OS) compared with patients in the ETV group both before (RFS: p<0.001; OS: p<0.001) and after (RFS: p=0.005; OS: p=0.035) PSM. TDF treatment was a favorable factor independently associated with RFS (HR: 0.58, 95%CI: 0.45-0.75, p<0.001) and OS (HR: 0.43, 95%CI: 0.28-0.66, p<0.001). In the low HBsAg cohort, no difference was observed in RFS and OS between the TDF group and the ETV group both before (RFS: p=0.140; OS: p=0.640) and after (RFS: p=0.480; OS: p=0.920) PSM. TDF treatment remained superiority after controlling for competing events by competing risk analysis in the high HBsAg cohort.
Conclusions: TDF treatment was superior to ETV treatment in improving RFS and OS of HBV-related HCC patients with high HBsAg level after liver resection. Even after controlling for survival competing events, the advantage of TDF treatment remained. Our findings may better help clinicians to assign individualized antiviral regimens to HBV-related HCC patients after liver resection.
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.