Clinical Features of HBV-Related HCC in Long-Term NAs-Treated Versus Untreated Patients

Patients who receive long-term anti-hepatitis B virus (HBV) treatment with nucleos(t)ide analogues (NAs) are still at risk for primary hepatocellular carcinoma (HCC). Aim The purpose of this study was to compare clinical features of HBV-related HCC in NA-treated vs. untreated patients. The records of patients who were diagnosed with HCC for the first time at the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 1, 2019 and September 31, 2024 were retrospectively reviewed. Patients with chronic HBV (CHB)-related HCC were grouped into the NA-treated group and untreated group. A total of 562 patients with CHB-related HCC were identified and divided into the NA treatment group (n = 146) and the untreated group (n = 416). Patient age was similar between the groups (50.9 ± 10.1 vs. 52.5 ± 12.1 years, p > 0.05). HBV DNA level, alanine aminotransferase (ALT) level and gamma glutamyl transpeptidase (GGT) level were significantly lower in the NA group (all, p < 0.001). Alpha fetoprotein (AFP) level was significantly higher in the untreated group (p < 0.05). However, the HBeAg positive rate was significantly greater in the NA group (27.4% vs. 17.5%, p < 0.05), and79.5% (116/146) of HCCs occurred in the first 5 years of NA treatment. Blood biochemical indexes and AFP values of patients who develop CHB-related HCC after NA treatment are usually normal. However, the high HBeAg seropositive rate in patients treated with NAs requires attention.