Tenofovir versus Entecavir on Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma After FOLFOX-Hepatic Arterial Infusion Chemotherapy

Abstract

Purpose The efficacy of entecavir (ETV) versus tenofovir (TDF) on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who underwent FOLFOX-hepatic arterial infusion chemotherapy (HAIC) remains unclear. In this study, we compared the outcomes between ETV and TDF in HBV-related advanced HCC patients who underwent FOLFOX-HAIC. Methods A total of 683 patients diagnosed with HBV-related HCC who underwent FOLFOX-HAIC and received TDF or ETV between January 2016 and December 2021 were included. Overall survival (OS), progression-free survival (PFS), HBV reactivation, and liver function of patients were compared between the ETV and TDF groups by propensity score matching (PSM). Results In the PSM cohort, for all patients and patients with ≥ 4 cycles of FOLFOX-HAIC, the median OS in the ETV group (15.2 months, 95% CI: 13.0–17.4 months; 16.6 months, 95% CI: 14.8–18.5 months; respectively) was shorter than that in the TDF group (23.0 months, 95% CI: 10.3–35.6 months; 27.3 months, 95% CI: 16.5-NA months; p =0.024, p =0.028; respectively). The median PFS in the ETV group (8.7 months, 95% CI: 7.9–9.5 months; 8.9 months, 95% CI: 8.0–9.8 months; respectively) was also shorter than that in the TDF group (11.8 months, 95% CI: 8.0–15.6 months; 12.7 months, 95% CI: 10.8–14.6 months; p =0.036, p =0.025; respectively). The rate of HBV reactivation in the ETV group was higher than that in the TDF group (12.3% vs 6.3%, p =0.040; 16.5% vs 6.2%, p =0.037, respectively). For liver function, the rate of ALBI grade that remained stable or improved in the ETV group was lower than that in the TDF group (44.6% vs 57.6%, p =0.006; 37.2% vs 53.8%, p =0.019, respectively). Conclusion Compared with ETV, TDF was associated with a better prognosis, lower proportion of HBV reactivation, and better preservation of liver function in advanced HBV-HCC patients who underwent FOLFOX-HAIC, especially those who received ≥ 4 cycles.