Effect of antiviral therapy on 3-year recurrence and prognosis of hepatocellular carcinoma after curative radiofrequency ablation

doi:10.4251/wjgo.v17.i11.112689

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Oncol. Nov 15, 2025; 17(11): 112689
Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.112689

Effect of antiviral therapy on 3-year recurrence and prognosis of hepatocellular carcinoma after curative radiofrequency ablation

Bai-Guo Xu, Xue Zhang, Fang Liu, Feng-Hui Li, Xu Zhang, Hui-Ling Xiang, Jing Liang

Bai-Guo Xu, Xue Zhang, Fang Liu, Feng-Hui Li, Hui-Ling Xiang, Jing Liang, Department of Gastroenterology and Hepatopathy, The Central Hospital of Tianjin University, Tianjin 300170, China

Bai-Guo Xu, Department of Gastroenterology and Hepatopathy, The Third Central Hospital of Tianjin, Tianjin 300170, China

Bai-Guo Xu, Department of Gastroenterology and Hepatopathy, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China

Xue Zhang, Hui-Ling Xiang, Department of Gastroenterology and Hepatopathy, The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China

Fang Liu, Department of Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China

Feng-Hui Li, Xu Zhang, Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin 300170, China

Xu Zhang, Department of Gastroenterology and Hepatology, The Central Hospital of Tianjin University, Tianjin 300170, China

Jing Liang, Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China

Co-first authors: Bai-Guo Xu and Xue Zhang.

Author contributions: Xu BG and Liang J designed and conceptualized the research; Zhang X, Xiang HL, Liu F, Li FH, and Zhang X performed the research (including data collection and preliminary data sorting); Zhang X and Zhang X contributed to the development of analytic tools for survival data processing; Zhang X and Liang J analyzed the data (including statistical analysis of baseline characteristics and survival curves); Xu BG, Liang J, and Zhang X wrote and revised the manuscript. Xu BG and Zhang X contributed equally to this work.

Supported by Tianjin Health Project of China, No. TJWJ2022XK029.

Institutional review board statement: This project was performed in concordance with the Declaration of Helsinki. This study was approved by the medical ethics committee of The Third Central Hospital of Tianjin, China (date of approval: 27 December 2019; approval number: IRB2019-040-01).

Informed consent statement: Informed consent was obtained from each patient. All data were analysed anonymously.

Conflict-of-interest statement: The authors declare no conflict of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that related to the findings of our study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Jing Liang, Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, No. 83 Jintang Road, Tianjin 300170, China. haolele77@sina.com

Received: August 4, 2025
Revised: August 25, 2025
Accepted: October 9, 2025
Published online: November 15, 2025
Processing time: 103 Days and 9.5 Hours

Abstract

BACKGROUND

The impact of entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF) on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellular carcinoma (HCC) who undergo curative radiofrequency ablation (RFA) remains unclear.

AIM

To compare the 3-year recurrence and survival rates among HCC patients receiving these three first-line oral anti-hepatitis B virus (anti-HBV) agents after RFA.

METHODS

This retrospective cohort study included patients with hepatitis B cirrhosis who were initially diagnosed with HCC at Tianjin Third Central Hospital, China, from August 2018 to December 2020, and had complete clinical data. All patients were followed up for at least 144 weeks. Cox regression analysis was performed to identify independent risk factors for HCC recurrence. Recurrence-free survival was analyzed using Kaplan-Meier curves, and Cox regression models were constructed after adjusting for gamma-glutamyl transferase, alpha-fetoprotein, and Barcelona Clinic Liver Cancer staging.

RESULTS

A total of 319 patients receiving oral anti-HBV therapy were divided into three groups: ETV group (n = 191), TDF group (n = 76), and TAF group (n = 52). At 6 and 12 months, there were no significant differences in recurrence rates between the groups. However, at 24 and 36 months, the TDF and TAF groups exhibited significantly lower recurrence rates compared with the ETV group [24 months: TDF, hazard ratio (HR) = 0.51, 95% confidence interval (CI): 0.29-0.91, P = 0.022; TAF, HR = 0.54, 95%CI: 0.28-1.03, P = 0.046; 36 months: TDF, HR = 0.57, 95%CI: 0.35-0.93, P = 0.025; TAF, HR = 0.54, 95%CI: 0.31-0.96, P = 0.037]. The 3-year mortality rates were similar across the three groups (ETV: 21.47%, TDF: 18.42%, TAF: 23.08%; P = 0.790).

CONCLUSION

Among patients with hepatitis B cirrhosis-related HCC, TDF and TAF are associated with lower 2-year and 3-year HCC recurrence rates after curative RFA treatment compared with ETV. However, there were no significant differences in 3-year mortality rates between the ETV, TDF, and TAF groups.

Keywords: Hepatitis B cirrhosis; Hepatocellular carcinoma; Nucleos(t)ide analogue; Radiofrequency ablation; Hepatocellular carcinoma recurrence

Core Tip: In patients with hepatitis B cirrhosis-related hepatocellular carcinoma who undergo curative radiofrequency ablation, tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide fumarate (TAF) are associated with lower 2-year and 3-year recurrence rates compared with entecavir, while no significant differences are observed in 3-year mortality rates. These findings support the consideration of TDF or TAF as preferred antiviral therapies for the long-term management of such patients.