# Effect of nucleos(t)ide analogue discontinuation on the prognosis of HBeAg‐negative hepatitis B virus‐related hepatocellular carcinoma after hepatectomy: A propensity score matching analysis

## TL;DR

This study finds that discontinuing antiviral drugs may improve outcomes for some hepatitis B-related liver cancer patients after surgery.

## Contribution

Identifies HBsAg-negative patients with hepatitis B-related liver cancer may benefit from stopping nucleos(t)ide analogues after surgery.

## Key findings

- Nucleos(t)ide analogue continuation was an independent risk factor for recurrence-free survival in HBsAg-negative patients.
- NA discontinuation was associated with better recurrence-free survival and comparable overall survival in HBsAg-negative patients.
- HBsAg status significantly interacted with nucleos(t)ide analogue continuation or discontinuation outcomes.

## Abstract

Although nucleos(t)ide analogues (NAs) are thought to reduce the risk of hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC), the effect of NA discontinuation on the prognosis of HBV‐related HCC after hepatectomy is rarely reported. We aimed to investigate the potential for hepatitis B virus e antigen (HBeAg)‐negative HBV‐related HCC patients to discontinue NAs based on preoperative hepatitis B virus surface antigen (HBsAg) status.

This historical cohort study involved 1232 NA‐treated HBeAg‐negative patients who underwent curative hepatectomy for HBV‐related HCC from 2014 to 2019. The recurrence‐free survival (RFS) and overall survival (OS) of patients discontinuing NAs before surgery were compared with those continuing NAs. Propensity score matching (PSM) was used to balance baseline characteristics.

Of all enrolled patients, 839 (68.1%) patients continued NAs, and 393 (31.9%) patients discontinued NAs. Continuation of NAs was identified as an independent risk factor for RFS (HR 2.047, 95% CI 1.348–3.109, p < 0.001 before PSM and HR 2.756, 95% CI 1.537–4.942, p < 0.001 after PSM) in HBsAg‐negative patients. Similarly, subgroup survival analyses showed that NA discontinuation was associated with better RFS (p = 0.029 before PSM and p < 0.001 after PSM) and comparable OS (p = 0.935 before PSM and p = 0.115 after PSM) than NA continuation in HBsAg‐negative patients. The interaction between HBsAg status and continuation or discontinuation of NAs was significant (p for interaction <0.001).

These findings demonstrate the potential for HBeAg‐negative HBV‐related HCC patients who have achieved HBsAg seroclearance to discontinue NAs under strict monitoring.