Effect of Nucleos(t)ide Analogs on Patients with Intermediate and Advanced Hepatitis B Virus-Related Hepatocellular Carcinoma

BackgroundThe role of nucleos(t)ide analogs (NAs) therapy in intermediate and advanced hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unclear.AimsThe aim was to evaluate the effect of NAs therapy on survival of intermediate- and advanced-stage HBV-related HCC patients initially treated with chemoembolization.MethodsA total of 1016 Barcelona Clinic Liver Cancer (BCLC) stage B/C HBV-related HCC patients initially treated with chemoembolization were included. Propensity score matching (PSM) was performed to decrease heterogeneity between the antiviral and non-antiviral groups. Kaplan-Meier and Cox regression analysis were performed to evaluate the effects of NAs therapy on overall survival (OS).ResultsAntiviral group (n=394) significantly prolonged OS compared with non-antiviral group (n=622) (p=0.003). NAs therapy (p<0.001) along with tumor size (p=0.002), tumor number (p=0.001), gross vascular invasion (p<0.001), metastasis (p<0.001), alpha-fetoprotein (p<0.001), Child-Pugh score (p=0.008), aspartate aminotransferase (p<0.001), and HBV DNA (p=0.018) were identified as independent prognostic factors for OS. After PSM processing, deducting the influence of subsequent treatments for HCC, NAs therapy was still identified as an independent protective factor (p=0.009) for OS in patients who survived >= 7months, regardless of BCLC stage B or C HCC.ConclusionNAs therapy prolongs OS in intermediate- and advanced-stage HBV-related HCC patients initially treated with chemoembolization. After PSM processing, patients who survived >= 7months still benefited from NAs therapy.