title: Adefovir dipivoxil is less expensive than lamivudine and associated with similar prognosis in patients with hepatitis B virus-related hepatocellular carcinoma after radical resection.
abstract: OBJECTIVE
  Lamivudine (LAM) and adefovir dipivoxil (ADV) are widely used in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), but few studies have directly compared their therapeutic efficacy and treatment cost. This study aims to compare LAM with ADV head-to-head in these patients.
  
  
  METHODS
  We retrospectively analyzed 201 patients with HBV-related HCC who underwent radical resection and subsequently received LAM (n=155) or ADV (n=46). The two groups were compared in terms of HBV-DNA levels, liver function, antiviral resistance, recurrence-free, and overall survival, as well as antiviral medication costs.
  
  
  RESULTS
  Despite significant improvement in HBV-DNA and alanine aminotransferase level in the LAM group after 1 year of antiviral therapy, these parameters did not differ significantly between the two groups over the following 2 years. Incidence of antiviral resistance after 1, 2, and 3 years of antiviral treatment was significantly higher in the LAM group (19.5%, 45.7%, and 56.4%) than in the ADV group (0%, 3.3%, and 14.5%;P<0.001). Overall survival at 1, 2, and 3 years after resection was similar for the LAM group (84.5%, 69.3%, and 64.6%) and the ADV group (84.1%, 77.8%, and 63.4%;P=0.905). Recurrence-free survival at the three follow-up points was also similar for the LAM group (71.7%, 58.3%, and 43.9%) and the ADV group (81.1%, 66.1%, and 53.0%;P=0.452). Cox regression analysis confirmed that both nucleos(t)ide analogues were associated with similar overall and recurrence-free survival. However, the average medication costs after 1, 2, and 3 years of antiviral treatment were significantly higher in the LAM group (€3.0, €4.8, and €5.6 per person per day) than in the ADV group (€2.2, €2.4, and €3.1 per person per day; allP<0.05).
  
  
  CONCLUSIONS
  ADV and LAM are associated with similar survival benefit in patients with HBV-related HCC after radical resection, but ADV is more cost-effective.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Zhong
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming.
authors.forename: Yang
authors.initials: Y
authors.lastname: Ke
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Zhu
authors.affiliation: Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Pathology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China.
authors.forename: Cheng-Piao
authors.initials: CP
authors.lastname: Luo
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Gong
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: You
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Liang
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Bang-De
authors.initials: BD
authors.lastname: Xiang
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning.
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
keywords: adefovir dipivoxil; hepatitis B virus; hepatocellular carcinoma; lamivudine; radical resection