The role of lamivudine versus entecavir in prevention of HCC in patients with hepatitis B virus-related cirrhosis

Background

In Romania, the incidence of hepatocellular carcinoma (HCC) has increased over the past ten years due to the increasing number of cirrhotic patients (more than 90% of the cases of HCC develop in cirrhosis). Antiviral nucleos(t)ide analogues have been widely used to reduce the development of HCC in chronic hepatitis B patients with fibrosis or cirrhosis.

Methods

We included 36 patients with hepatitis B virus related cirrhosis. Since February 2008 until now, 45% (16 patients) were treated with lamivudine and 55% (20 patients) with entecavir. The evaluation was performed every 3-4 months by clinical exam, biochemical and serological tests, and abdominal ultrasonography for all patients. Upper endoscopy, computed tomography scanning or magnetic resonance imaging were done in selective cases.

Results

The median age at the diagnosis of cirrhosis was 57.6±10.7 years and 75% of patients were males. Six cases (16.66%) were diagnosed with HCC – all of them were males. Only one of these patients was treated with entecavir, while the rest received lamivudine. Risk factors involved in carcinogenesis were represented by: age over 60, male gender, cirrhosis evolution for more than 5 years.

Conclusion

The results of this study suggested that the incidence of HCC is lower in patients with HBV-related cirrhosis who used entecavir (5%) compared to lamivudine (31%).