Comparison of incidence of hepatocellular carcinoma between chronic hepatitis B patients with cirrhosis treated with entecavir or tenofovir in Taiwan - a retrospective study

Whether tenofovir disoproxil fumarate (TDF) is superior to entecavir in lowering the risk of hepatocellular carcinoma (HCC) development remains controversial. This retrospective study compared the incidences of HCC, cirrhotic events, and mortality between patients treated with entecavir and TDF. The study enrolled 1560 chronic hepatitis B (CHB) patients with cirrhosis from 2008 through 2018. All patients received entecavir or TDF monotherapy for at least 12 months before enrollment. Patients who had HCC or liver transplantation at initial treatment or within the first year of entecavir or TDF therapy were excluded. In the entire cohort, the cumulative incidence rates of HCC at 3, 5, and 10 years were 9.5%, 15.2%, and 25.4%, respectively. The entecavir group had a higher cumulative incidence of HCC than the TDF group (P = 0.001). A Cox regression analysis showed that entecavir group, old age, male sex, hepatic decompensation, diabetes mellitus, lower albumin levels, and platelet count were independent predictors of HCC. TDF treatment was significantly associated with a lower risk of HCC compared to entecavir treatment after adjustment with propensity score matching or inverse probability of treatment weighting in all patients. However, this association was not observed in patients with compensated cirrhosis at entry or patients enrolled after 2011, including after adjustment with propensity score matching or inverse probability of treatment weighting. No significant differences were observed in cirrhotic events and mortality or liver transplantation between the entecavir and TDF groups. In conclusion, the incidences of HCC did not differ significantly between patients with compensated cirrhosis or those enrolled over the same period treated with entecavir or TDF.