studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 387A
The following authors have nothing to disclose: Suraj Sharma, Matthew Kowgier,
Bettina E. Hansen, Korosh Khalili, Willem Pieter Brouwer, Gideon Hirschfield
The following authors have nothing to disclose: Yee-Kit Tse, Terry C. Yip
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Oral nucleos(t)ide analogues (NAs) improve survival
of patients with hepatocellular carcinoma after tumor
resection but not after other treatment modalities – a
study of 2,198 patients with chronic hepatitis B
Grace LH Wong, Yee-Kit Tse, Vincent W. Wong, Terry C. Yip,
Henry Lik-Yuen Chan; Institute of Digestive Disease, The Chinese
University of Hong Kong, Shatin, Hong Kong
Background: Oral nucleos(t)ide analogues (NAs) effectively
suppress hepatitis B virus (HBV) and reduce tumor recurrence
and death in patients with HBV-related hepatocellular carcinoma
(HCC). We aimed to investigate the effect of NAs on
the clinical outcomes after different HCC treatments (tumor
resection, local ablative therapy [LAT], transartierial chemoembolization
[TACE]) for HCC in these patients. Methods: We
conducted a territory-wide cohort study using the database
from Hospital Authority, which provides medical services at
both in-patient and out-patient settings for 70-80% of the Hong
Kong citizens. We identified chronic hepatitis B (CHB) patients
with HCC by International Classification of Diseases, Ninth
Revision, Clinical Modification (ICD-9-CM) diagnosis codes,
diagnosed between 2000 and 2012. HCC treatments, NA
use and laboratory parameters were retrieved and studied.
The primary outcome was HCC recurrence and death. A
3-month landmark analysis was used to evaluate the relative
risk of primary outcome in patients with or without NA treatment.
Cox proportional hazards models were used to estimate
adjusted HRs with 95% CIs of HCC recurrence (taking death
into account as a competing risk) and mortality associated
with post-treatment use of NA. Results: 2,198 CHB patients
(1,230 NA-untreated and 968 NA-treated) with HCC received
at least one type of HCC treatment were included in the analysis.
Tumor resection, LAT, TACE, resection-LAT and resection/
LAT-TACE were the HCC treatments in 810 (36.9%), 1,015
(46.2%), 222 (10.1%), 73 (3.3%) and 78 (3.5%) patients.
At a median follow-up of 2.8 years (IQR 1.4 – 4.9 years)”,
tumor recurrence and death occurred in 451 (36.7%) and 578
(47.0%) of NA-untreated subjects; and 216 (22.3%) and 301
(31.1%) of NA-treated subjects. NA therapy reduced the risk of
overall HCC recurrence (adjusted sub-hazard ratio [SHR] 0.62,
95% confidence interval [CI] 0.49–0.80; P 60
years old). Results: Surveillance starts to be effective above 45
years of age (gaining >100 quality-adjusted life days) though
it is still relatively cost-ineffective with an incremental cost-effectiveness
ratio (ICER) of $88,160/QALY. As the starting age
of surveillance increases, the ICER for surveillance decreases.
Beyond the age of 58, the ICER for surveillance is consistently
lower than the standard willingness-to-pay threshold of
$50,000/QALY. Conclusions: Due to the marked decrease in
HCC incidence, universal screening in patients with cirrhosis
post-SVR is very unlikely to be cost-effective; however, by targeting
surveillance to those over 55 years of age (figure), HCC
surveillance would represent better value-for-money. Data to
identify high-risk populations may allow for further tailoring of
recommendations according to a patient’s risk profile.