title: Antiviral drug resistance increases hepatocellular carcinoma: a prospective decompensated cirrhosis cohort study.
abstract: OBJECTIVE
  To study the clinical outcome of antiviral therapy in hepatitis B-related decompensated cirrhotic patients.
  
  
  METHODS
  Three hundred and twelve patients with decompensated hepatitis B cirrhosis were evaluated in a prospective cohort. With two years of follow-up, 198 patients in the group receiving antiviral therapy with nucleos(t)ide analogues and 39 patients in the control group without antiviral treatment were analysed.
  
  
  RESULTS
  Among the antiviral treatment patients, 162 had a complete virological response (CVR), and 36 were drug-resistant (DR). The two-year cumulative incidence of hepatocellular carcinoma (HCC) in the DR patients (30.6%) was significantly higher than that in both the CVR patients (4.3%) and the control group (10.3%) (P < 0.001). Among the DR patients in particular, the incidence of HCC was 55.6% (5/9) in those who failed rescue therapy, which was extremely high. The rtA181T mutation was closely associated with rescue therapy failure (P = 0.006). The Child-Pugh scores of the CVR group were significantly decreased compared with the baseline (8.9 ± 2.3 vs 6.0 ± 1.3, P = 0.043).
  
  
  CONCLUSIONS
  This study showed that antiviral drug resistance increased the risk of HCC in decompensated hepatitis B-related cirrhotic patients, especially in those who failed rescue therapy.
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Chun-Lei
authors.initials: CL
authors.lastname: Fan
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Pei-Ling
authors.initials: PL
authors.lastname: Dong
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Fei-Li
authors.initials: FL
authors.lastname: Wei
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: De-Xi
authors.initials: DX
authors.lastname: Chen
authors.affiliation: Lei Li, Yu-Han Chen, Chun-Lei Fan, Pei-Ling Dong, Bing Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You'an Hospital Affiliated with Capital Medical University, Beijing 100069, China.
authors.forename: Hui-Guo
authors.initials: HG
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000821:virology*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000821:virology*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents
keywords: Decompensated cirrhosis; Drug resistance; Hepatitis B; Hepatocellular carcinoma; Nucleos(t)ide analogues