Oral medications enhance adherence to surveillance for hepatocellular carcinoma and survival in chronic hepatitis B patients

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

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6 Scopus citations

Abstract

Background/Aims: 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). Methods: 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. Results: 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. Conclusions: Prescription of oral medication improves compliance to surveillance and enables early detection of HCC, which is associated with enhanced survival.

Original languageEnglish
Article numbere0166188
JournalPLoS ONE
Volume12
Issue number1
DOIs
StatePublished - Jan 2017

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