恩替卡韦与替诺福韦酯抗病毒治疗降低慢性乙型肝炎患者肝细胞癌发生风险的差异——一项韩国回顾性研究引发的思考

Effect of entecavir versus tenofovir disoproxil fumarate antiviral therapy in reducing the risk of hepatocellular carcinoma in patients with chronic hepatitis B: Reflections on a Korean retrospective study

近期,韩国学者Choi等在《JAMA Oncology》杂志上发表了一项真实世界研究,结果显示在降低慢性乙型肝炎(CHB)患者肝细胞癌发生风险方面,恩替卡韦治疗组与替诺福韦酯治疗组存在明显差异。这一结果与当前CHB抗病毒治疗领域的主流观点不尽相同,引起了学术界强烈讨论。该杂志同步发表的编辑述评中指出,该研究具有一定的临床意义,但仍存在诸多混杂因素有待进一步研究阐明,不应据此更改CHB患者的抗病毒治疗方案。以该研究为切入点,分析和探讨CHB患者接受长期核苷(酸)类药物抗病毒治疗的肝细胞癌发生风险受哪些关键因素影响。

Recently,Choi et al.published a real-world study in JAMA Oncology,which showed that there was a significant difference between the entecavir group and the tenofovir disoproxil fumarate group in reducing the risk of hepatocellular carcinoma(HCC)in chronic hepatitis B(CHB)patients.This result is inconsistent with the common point of view in antiviral therapy for CHB and has aroused a heated discussion in the academic world.The editorial simultaneously published in JAMA Oncology pointed out that the study by Choi et al.has certain clinical significance,but there are still many confounding factors which need to be further clarified,and therefore,the regimen of antiviral therapy for CHB patients cannot be changed based on this result.With reference to this result,this article analyzes the key influencing factors for the risk of HCC in CHB patients receiving long-term antiviral therapy with NAs.