Effects of long-term entecavir treatment on the incidence of hepatocellular carcinoma in chronic hepatitis B patients

Entecavir is one of the most-used nucleoside analogues for the treatment of patients with chronic hepatitis B virus (HBV) infection. The aim of this study was to clarify the effects of long-term entecavir treatment on the incidence of hepatocellular carcinoma (HCC). The participants were 249 patients with chronic HBV infection who had been treated by entecavir for more than 2 years. Hepatic functional reserve and incidence of HCC were evaluated, and the factors that might contribute to the development of HCC were analyzed. Prothrombin activity was significantly elevated at 60 months after starting entecavir (from 85.9 +/- A 17.4 to 97.0 +/- A 16.9 %, p < 0.001). The albumin level was also significantly elevated at 60 months after starting entecavir (from 4.0 +/- A 0.5 to 4.3 +/- A 0.3 mg/dL, p < 0.001). The annual incidence of HCC decreased over time, and the incidence of HCC was only 1.8 % at 5 years after starting entecavir. On multivariate analysis for HCC incidence, older age and low platelet count were significant, independent contributing factors. Long-term treatment with entecavir improved hepatic functional reserve and decreased the incidence of HCC over time after 3 years. To decrease the incidence of HCC, careful induction of long-term entecavir treatment in younger patients with chronic HBV infection and better hepatic functional reserve would be important.