Interferon-based treatment is superior to nucleos(t)ide analog in reducing HBV-related hepatocellular carcinoma for chronic hepatitis B patients at high risk

ABSTRACT

Background: The effect of nucleos(t)ide analogs (NAs) versus interferon (IFN) on the occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) is controversial. We assessed whether antiviral strategy affected HCC development in CHB patients at different HCC risks.

Methods: 1112 CHB patients with antiviral therapy were included in this retrospective study. Patients treated with NAs only were classified into NAs group (n = 682) while those received IFN treatment with or without NAs were defined as IFN group (n = 430). Propensity score matching (PSM) was applied to minimize baseline differences.

Results: Totally, 31 patients developed HCC during follow-up (median 5.41 years). The cumulative HCC incidence at 10 years was significantly lower in the IFN group than NAs group (2.7% vs 8.0%, p < 0.001). Similar results were obtained in the PSM-cohort. Patients with IFN-based treatment were less likely to develop HCC than those with NAs (Hazard ratio = 0.15; 95% CI 0.04–0.66; p = 0.012). Subgroup analyses demonstrated that this superiority of IFN in reducing HCC development was obvious in patients at high- but not low-risk of HCC.

Conclusions: Reduction of HCC development was more significant in CHB patients at higher HCC risk with IFN-based therapy than NAs treatment.

KEYWORDS:

• Chronic hepatitis B
• hepatocellular carcinoma
• interferon
• nucleos(t)ide analogs

Acknowledgements

The authors acknowledge all the patients who were recruited in the study. We also thank the clinical and research staff from the Department of Infectious Diseases, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.

Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author Contributions

Study concept and design: P.P.R. and Q.X.; study coordination: P.P.R, H.L.G., Y.M.X, Z.J.C and Q.X.; data collection: R.D.M., Y.H.L., L.C.C., Z.Q.L., T.H.Z., J.L., Y.Y.L., Q.G., R.C., H.J.Z., X.G.X., W.C., H.W., Y.M.X., H.L.G.; data analysis: P.P.R. and Z.J.C.; data interpretation: Y.M.X., H.L.G., W.C., H.W., S.S.B., Q.X., P.P.R. and Z.J.C.; drafting the manuscript: P.P.R. and Z.J.C.; critical revision of the manuscript: Y.M.X., H.L.G., S.S.B. and Q.X. All authors have approved the final manuscript to be published and agreed to be accountable for all aspects of the work.

Supplementary materials

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Additional information

Funding

This work was supported by the National Natural Science Foundation of China [No.81570535, No.81770587, No.81600463], the National Key Programs on Infectious Diseases of China [2017ZX10202202-005-004, 2017ZX10203201-008], the Shanghai Three-Year Plan of the Clinical Skills and Innovations [16CR1002A], the National Clinical Key Specialty Construction Project of China (Infectious Diseases) and the Three-year Action Plan of Public Health in Shanghai [15GW2K0102].