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Association Between Level of Fibrosis, Rather Than Antiviral Regimen, and Outcomes of Patients With Chronic Hepatitis B

Authors
 Hye Soo Kim  ;  Beom Kyung Kim  ;  Seung Up Kim  ;  Jun Yong Park  ;  Do Young Kim  ;  Ki Jun Song  ;  Jung Won Park  ;  Yeong Jin Kim  ;  Oidov Baatarkhuu  ;  Kwang-Hyub Han  ;  Sang Hoon Ahn 
Citation
 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol.14(11) : 1647-1656, 2016 
Journal Title
 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 
ISSN
 1542-3565 
Issue Date
2016
MeSH
Adult ; Antiviral Agents/therapeutic use* ; Carcinoma, Hepatocellular/prevention & control* ; Elasticity Imaging Techniques ; Female ; Guanine/analogs & derivatives ; Guanine/therapeutic use ; Hepatitis B, Chronic/complications* ; Hepatitis B, Chronic/drug therapy* ; Humans ; Lamivudine/therapeutic use ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/complications* ; Liver Cirrhosis/drug therapy* ; Liver Neoplasms/prevention & control* ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Treatment Outcome
Keywords
Entecavir ; Hepatocellular Carcinoma ; Lamivudine ; Transient Elastography
Abstract
BACKGROUND & AIMS: We performed a propensity-score matched analysis to investigate whether entecavir, compared with lamivudine, can reduce risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B after adjusting for level of fibrosis. METHODS: We performed a retrospective study of 1079 patients with chronic hepatitis B who received first-line therapy with lamivudine (n = 435) or entecavir (n = 644) from 2006 through 2013. Only patients with available liver stiffness value measured by transient elastography were recruited. Liver cirrhosis was diagnosed by ultrasonography. To adjust for the imbalance of patients treated with lamivudine versus entecavir, we performed propensity-score matching (PSM), at a ratio of 1:1, using 7 factors (age, sex, hepatitis B e antigen, alanine aminotransferase, serum albumin, platelet count, and liver stiffness; PSM1) or 8 factors (variables of PSM1 plus ultrasonography measurements of cirrhosis; PSM2). Patients with virologic breakthrough or resistance mutations received rescue therapy. RESULTS: Over the 7-year period, 91 patients developed HCC and 104 had liver-related events in the entire cohort. In multivariate analyses, level of fibrosis, but not antiviral regimen, was independently associated with risk of HCC (P < .05). The PSM1 group included 342 pairs of patients and the PSM2 group included 338 pairs. Similar proportions of patients given lamivudine versus entecavir developed HCC in each model (10.5% given lamivudine vs 9.9% given entecavir in PSM1 and 11.9% vs 12.6% in PSM2; all P > .05). When PSM was applied to patients with liver stiffness value ≤13 kPa or >13 kPa, patients given lamivudine versus entecavir still had similar cumulative rates of HCC development (all P > .05). CONCLUSIONS: In a PSM analysis, we associated level of fibrosis, rather than antiviral regimen, with risk of HCC, when patients received appropriate rescue therapy in case of virologic breakthrough or resistance mutations.
Full Text
http://www.sciencedirect.com/science/article/pii/S1542356516303032?via%3Dihub
DOI
10.1016/j.cgh.2016.05.039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Young Jin(김영진)
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Song, Ki Jun(송기준) ORCID logo https://orcid.org/0000-0003-2505-4112
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/153170
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