替诺福韦与恩替卡韦对乙型肝炎病毒相关肝细胞癌预后的研究进展

摘要/Abstract

摘要： 抗病毒治疗是改善慢性乙型肝炎病毒(HBV)感染相关肝细胞癌(HCC)患者预后的核心手段。替诺福韦(TDF)与恩替卡韦(ETV)作为一线核苷(酸)类似物(NAs),其选择对患者长期生存的影响已成为临床研究的热点。近年来,国内外多项临床研究及荟萃分析对TDF与ETV在慢性HBV感染者HCC风险防控以及HBV相关HCC预后影响中的差异进行了深入探讨。本综述系统汇总近年研究证据,从降低HCC发病率及发生风险、减少HCC复发率及复发风险、改善无复发生存期、延长总生存期、降低死亡率及肝移植率等维度,全面比较两者的临床疗效差异,旨在为临床决策提供循证支持。

关键词: 替诺福韦, 恩替卡韦, 乙型肝炎病毒, 肝细胞癌, 治疗, 预后

黄珍, 刘娜, 徐光华, 周路路. 替诺福韦与恩替卡韦对乙型肝炎病毒相关肝细胞癌预后的研究进展[J]. 肝脏, 2026, 31(7): 1051-1054.

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参考文献

[1] 丁洋, 李尧, 卢秉超, 等. 2024年病毒性肝炎相关临床研究进展[J]. 中华肝脏病杂志, 2025, 33(1): 3-6.
[2] 中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024 年版)[J]. 中华消化外科杂志,2024, 23 (4): 429-478.
[3] Yip T C F, Wong V W S, Chan H L-Y, et al. Tenofovir is associated with lower risk of hepatocellular carcinoma than entecavir in patients with chronic HBV infection in China[J]. Gastroenterology, 2020, 158(1): 215-225.
[4] Zhang Z, Zhou Y, Yang J, et al. The effectiveness of TDF versus ETV on incidence of HCC in CHB patients: a meta analysis[J]. BMC Cancer, 2019, 19(1):511.
[5] 周宇辰, 胡承光, 袁国盛, 等. 抗病毒联合抗肝纤维化治疗慢性乙型肝炎肝纤维化降低肝细胞癌发生:144周的前瞻性队列研究[J]. 南方医科大学学报, 2019, 39(6): 633-640.
[6] Huang Y, Chen L, Huang R, et al. Tenofovir is superior to entecavir in reducing HCC for patients with HBV-related compensated cirrhosis at high HCC risk scores[J]. Ther Adv Chronic Dis, 2022, 13: 20406223221102791.
[7] He L Y, Xia Z J, Zhang X Y, et al. Tenofovir versus entecavir on the prognosis of hepatitis B-related hepatocellular carcinoma after surgical resection: a randomised controlled trial[J]. Int J Surg, 2023, 109(10): 3032-3041.
[8] Li P, Wang Y, Yu J, et al. Tenofovir vs entecavir among patients with HBV-related HCC after resection[J]. JAMA Netw Open, 2023, 6(10): e2340353.
[9] Tsai M C, Wang C C, Lee W C, et al. Tenofovir is superior to entecavir on tertiary prevention for BCLC stage 0/a hepatocellular carcinoma after curative resection[J]. Liver Cancer, 2022, 11(1): 22-37.
[10] Wang X H, Hu Z L, Fu Y Z, et al. Tenofovir vs. entecavir on prognosis of hepatitis B virus-related hepatocellular carcinoma after curative resection[J]. J Gastroentero, 2022, 57(3): 185-198.
[11] Shen J Y, Qi W L, Dai J L, et al. Tenofovir vs. entecavir on recurrence of hepatitis B virus-related hepatocellular carcinoma beyond milan criteria after hepatectomy[J]. Chin Med J(Engl), 2021, 135(3): 301-308.
[12] Choi J, Jo C, Lim Y S. Tenofovir versus entecavir on recurrence of hepatitis B virus-related hepatocellular carcinoma after surgical resection[J]. Hepatology , 2021, 73(2): 661-673.
[13] Peng J X, Wang L Z, Wang Q T, et al. Tenofovir versus entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma: a reconstructed individual patient data meta-analysis[J]. Front Pharmacol, 2024, 15: 1393861.
[14] Liu H, Han C L, Tian B W, et al. Tenofovir versus entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma: a systematic review and meta-analysis[J]. Expert Rev Gastroenterol Hepatol, 2023, 17(6): 623-633.
[15] Hu L, Yang C, Qiao Y, et al. A systematic review and meta-analysis comparing the impact of tenofovir and entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma patients undergoing liver resection[J]. Front Pharmacol, 2024, 15: 1443551.
[16] Zheng Z, Wang J, Wu T, et al. Tenofovir versus entecavir on outcomes of hepatitis B virus-related hepatocellular carcinoma after FOLFOX-hepatic arterial infusion chemotherapy[J]. J Hepatocell Carcinoma, 2023, 10: 2117-2132.
[17] Lu H, Zheng C, Xiong B, et al. TACE versus TACE+entecavir versus TACE+tenofovir in the treatment of HBV associated hepatocellular carcinoma[J]. BMC Cancer, 2023, 23(1): 235.
[18] Yang J, Chen Y, Sun H, et al. Tenofovir versus entecavir on decreasing risk of HBV-related hepatocellular carcinoma recurrence after liver transplantation[J]. Infect Agent Cancer, 2023, 18(1): 2.
[19] Liang Y, Zhong D, Zhang Z, et al. Impact of preoperative antiviral therapy on the prognosis of hepatitis B virus-related hepatocellular carcinoma[J]. BMC Cancer, 2024, 24(1):291.
[20] Kao W Y, Tan E C H, Lee H L, et al. Entecavir versus tenofovir on prognosis of hepatitis B virus-related hepatocellular carcinoma after curative hepatectomy[J]. Aliment Pharmacol Ther, 2023, 57(11): 1299-1312.
[21] Lee J H, Kim B K, Park S Y, et al. The efficacies of entecavir and tenofovir in terms of enhancing prognosis after curative treatment of hepatitis B virus-related hepatocellular carcinoma[J]. Euro J Intern Med, 2021, 89: 48-55.
[22] Hu Z, Zeng H, Hou J, et al. Tenofovir vs. Entecavir on outcomes of hepatitis B virus-related hepatocellular carcinoma after radiofrequency ablation[J]. Viruses, 2022, 14(4):656.
[23] Park J M, Choe W H, Kim J H, et al. The effect of nucleos(t)ide analogues on clinical outcomes of patients treated with transarterial chemoembolization and radiofrequency ablation for hepatitis B virus-related hepatocellular carcinoma[J]. J Liver Cancer, 2021, 21(2): 155-162.
[24] Kim D G, Choi Y, Rhu J, et al. Entecavir versus tenofovir on the recurrence of hepatitis B-related HCC after liver transplantation: a multicenter observational study[J]. Liver Transpl, 2023, 29(12): 1272-1281.