A systematic review and meta-analysis comparing the impact of tenofovir and entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma patients undergoing liver resection

TL;DR

This study compares how well tenofovir and entecavir affect survival and cancer recurrence in hepatitis B patients who had liver surgery for cancer.

Contribution

The study provides the first meta-analysis comparing the prognostic effectiveness of tenofovir and entecavir in HBV-related HCC patients.

Findings

Tenofovir improved overall survival, recurrence-free survival, and reduced early and late cancer recurrence compared to entecavir.

Publication bias was detected for overall survival but not for recurrence-free survival.

Further high-quality trials are needed to confirm the findings.

Abstract

Tenofovir (TDF) and entecavir (ETV) are highly effective and well-tolerated nucleos(t)ide analogs commonly prescribed for hepatitis B virus (HBV) treatment. Yet, it is unclear whether survival outcomes differ for HBV-related hepatocellular carcinoma (HCC) patients treated with ETV and TDF. Thus, this meta-analysis aimed to compare the prognostic effectiveness of ETV and TDF in HBV-related HCC patients.

We comprehensively searched four databases, PubMed, Web of Science, Embase, and the Cochrane Library, to identify pertinent studies utilizing keywords “entecavir,” “tenofovir,” “hepatocellular carcinoma,” and “liver resection.” Our primary outcomes of interest encompassed overall survival (OS), recurrence-free survival (RFS), early recurrence, and late recurrence. The statistical effect size for these measures was expressed in terms of hazard ratios (HRs).

Our search yielded 10 studies encompassing 11 datasets involving 7,400 patients. Our meta-analysis revealed that patients treated with TDF achieved better OS (HR = 0.53; 95% confidence interval [CI] = 0.40–0.70, p < 0.0001), RFS (HR = 0.68; 95% CI = 0.57–0.80; p < 0.0001), early recurrence (HR = 0.80; 95% CI = 0.67–0.94; p < 0.0077), and late recurrence (HR = 0.64; 95% CI = 0.43–0.97; p = 0.0368). We detected publication bias potentially affecting OS but not RFS.

Our findings demonstrated that TDF outperformed ETV regarding RFS for HBV-related HCC patients. However, to bolster the evidence and establish more conclusive conclusions, further validation via extensive and high-quality randomized controlled trials is essential.

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD 42024542579.

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