Journal Article

Oral Medications Enhance Adherence to Surveillance for Hepatocellular Carcinoma and Survival in Chronic Hepatitis B Patients

Kim, Jieun E., Yu, Su Jong, Cho, Young Youn, Yoo, Jeong-Ju, Nam, Joon Yeul, Cho, Yuri, Kim, Hwi Young, Kim, Yoon Jun, Chang, Young, Yoon, Jung-Hwan, Cho, Hyeki, Cho, EunJu, Lee, Minjong, Lee, Jeong-Hoon, Lee, Dong Hyeon

2017

Overview

Regular surveillance for hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients is essential to detect HCC earlier and to improve prognosis. This study investigated whether prescription of oral medication contributes to adherence to surveillance, early tumor detection, and overall survival (OS). A total of 401 CHB patients who were newly diagnosed with HCC were included: 134 patients received no medication (group 1), 151 received hepatoprotective agents such as ursodeoxycholic acid and silymarin (group 2), and 116 received antiviral agents (group 3) at two years before HCC diagnosis. The primary endpoint was OS, and secondary endpoints were compliance to regular surveillance and HCC status at diagnosis. Compared to group 1, both group 2 and 3 had higher rates of good compliance to regular surveillance (defined as participation in >80% of imaging intervals being ≤6 months) (58.2%, 90.1%, and 97.4%, respectively; P<0.001), more HCC diagnosed at a very early stage (20.9%, 32.5%, and 36.2%; P = 0.019) and smaller tumor size (2.8±2.4cm, 1.9±1.1cm, and 1.8±0.9cm; P<0.001). Finally, compared to group 1, both group 2 (hazard ratio, 0.63; 95% confidence interval, 0.41-0.97; P = 0.035) and group 3 (hazard ratio, 0.40; 95% confidence interval, 0.22-0.71; P = 0.002) had significantly longer OS. In mediation analysis, prolonged OS is resulted considerably from indirect effect mediated by shorter imaging interval (>100% in group 2 and 14.5% in group 3) rather than direct effect of medication itself. Prescription of oral medication improves compliance to surveillance and enables early detection of HCC, which is associated with enhanced survival.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Antioxidants - therapeutic use / Antiviral agents / Antiviral Agents - therapeutic use / Behavior / Biology and Life Sciences / Carcinoma, Hepatocellular - diagnosis / Carcinoma, Hepatocellular - drug therapy / Carcinoma, Hepatocellular - pathology / Cardiovascular disease / Cholagogues and Choleretics - therapeutic use / Chronic illnesses / Confidence intervals / Diagnosis / Dosage and administration / Drugs / Early Detection of Cancer - methods / Epidemiology / Female / Gastroenterology / Hepatitis / Hepatitis B / Hepatitis B virus / Hepatitis B, Chronic - drug therapy / Hepatitis B, Chronic - pathology / Hepatocellular carcinoma / Hospitals / Humans / Infections / Interferon / Internal medicine / Liver cancer / Liver cirrhosis / Liver Neoplasms - diagnosis / Liver Neoplasms - drug therapy / Liver Neoplasms - pathology / Male / Medical diagnosis / Medical prognosis / Medical research / Medical screening / Medicine and Health Sciences / Middle Aged / Oral drugs / Patient Compliance / Patient outcomes / Patients / Physicians / Preventive medicine / Prognosis / Psychopharmacology / Research and Analysis Methods / Retrospective Studies / Silymarin / Silymarin - therapeutic use / Studies / Surveillance / Survival / Ultrasonic imaging / Ursodeoxycholic acid / Ursodeoxycholic Acid - therapeutic use / Viral infections / Viruses