Clinical features of patients developing primary hepatocellular carcinoma during anti-HBV therapy with nucleos (t) ide analogues

Objective To investigate the clinical features of patients developing hepatocellular carcinoma ( HCC) during anti-hepatitis B virus ( HBV) therapy with nucleos ( t) ide analogues ( NAs) . Methods A total of 542 patients who were diagnosed with HCC for the first time in The Third Affiliated Hospital of Sun Yat-Sen University from January 2008 to September 2014 were enrolled, and they all had chronic HBV infection. According to the presence or absence of standard therapy with NAs, they were divided into antiviral group ( 130 patients) and non-antiviral group ( 412 patients) . A retrospective analysis was performed for their clinical data, including age, sex, family history of tumor, duration of HBV infection, the time when a confirmed diagnosis of liver cirrhosis was made, history of drinking, history of diabetes, history of medication, laboratory parameters, liver pathology, and imaging findings, and these data were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups, the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the non-antiviral group, the antiviral group had significant increases in the proportion of patients with liver cirrhosis ( 90. 0% vs 78. 4%, χ2= 8. 528, P = 0. 003) and HBe Ag-positive rate ( 29. 4% vs 18. 5%, χ2= 6. 794, P = 0. 009) .There was a significant difference in the constitution of HBV DNA between the two groups ( χ2= 173. 142, P < 0. 001) , as well as significant differences in alanine aminotransferase, gamma-glutamyl transpeptidase, and alpha-fetoprotein ( all P < 0. 001) . Compared with the non-antiviral group, the antiviral group had a higher proportion of patients with early-or intermediate-stage liver cancer, smaller and fewer cancer lesions, and a lower proportion of patients with vascular invasion or distant metastasis ( all P < 0. 001) . Among the patients in the antiviral group, 80% ( 104/130) developed HCC within 5 years of anti-HBV therapy. Conclusion Some patients with chronic HBV infection who receive long-term NAs as the anti-HBV therapy still develop HCC, especially those with liver cirrhosis, and most of these cases occur within 5 years of anti-HBV therapy. Most patients treated with NAs are diagnosed at the early stage of HCC, suggesting that standard follow-up is of vital importance.