替诺福韦二吡呋酯和恩替卡韦都是常用的一线抗病毒治疗药物，但其相对复发和总生存（OS）益处仍不清楚。 探讨替诺福韦二吡呋酯与恩替卡韦在肝切除术后无复发生存（RFS）和 OS 方面的差异与乙型肝炎病毒 (HBV) 相关的肝细胞癌 (HCC) 患者的治疗意图。这项回顾性队列研究于 2015 年 1 月 4 日至 4 月 1 日在中国上海三级转诊医院东方肝胆外科医院进行。 2023年。参与者包括2015年1月至2018年12月期间接受治疗性肝切除术的HBV相关HCC患者。使用倾向评分匹配将接受替诺福韦二吡呋酯的患者与接受恩替卡韦的患者以1:1的比例进行匹配。数据分析时间为 2023 年 4 月 3 日至 5 月 31 日。接受替诺福韦二吡呋酯或恩替卡韦作为 HBV 抗病毒治疗。主要终点为 RFS 和 OS 率。4451 名患者中（平均 [SD] 年龄，58.1 [10.0] 岁；3764 名男性[84.6%]；中位[范围]随访时间为 51 [3 至 91] 个月），每组中选择了 989 名患者进行倾向评分匹配。基线特征具有可比性。在倾向评分匹配组中，恩替卡韦组的 OS 率为 1 年 92.2%、3 年 70.9% 和 5 年 54.2%，而 1 年 90.9%、3 年 75.2% 和 64.0%服用替诺福韦二吡呋酯组 5 年。恩替卡韦组的 RFS 率为 1 年 83.9%、3 年 50.0% 和 5 年 43.3%，而替诺福韦二吡呋酯组 1 年、3 年和 5 年 RFS 率为 85.3%、55.6% 和 51.4%团体。替诺福韦二吡呋酯组患者具有更好的 OS（风险比，0.82；95% CI，0.72 至 0.94；P = .004）和 RFS 率（风险比，0.81；95% CI，0.72 至 0.92；P = .001）与恩替卡韦组相比。恩替卡韦组与替诺福韦二吡呋酯组的限制性平均生存时间差异在 1 年时为 -0.05 (95% CI, -0.18 至 0.08) 个月 (P = .45)，在 3 年时为 0.20 (95% CI, -0.62 至 1.03) 个月(P = .63)，5 年时为 1.82 (95% CI，0.14 至 3.51) 个月 (P = .03)。这些研究结果表明，在因 HBV 相关 HCC 接受治愈性肝切除术的患者中，替诺福韦二吡呋酯与与恩替卡韦相比，具有更好的长期 OS 和 RFS 率，为抗病毒治疗提供了见解。

Tenofovir disoproxil and entecavir are both commonly used first-line antiviral treatments, but their comparative recurrence and overall survival (OS) benefits remain unclear.To explore differences of tenofovir disoproxil vs entecavir in recurrence-free survival (RFS) and OS after liver resection with curative intent in patients with hepatocellular cancer (HCC) related to hepatitis B virus (HBV).This retrospective cohort study was conducted at Eastern Hepatobiliary Surgery Hospital, a tertiary referral hospital in Shanghai, China, between January 4, 2015, and April 1, 2023. Participants included patients with HBV-related HCC who underwent liver resection with curative intent from January 2015 to December 2018. Patients who received tenofovir disoproxil were matched with patients who received entecavir in a 1:1 ratio using propensity score matching. Data were analyzed from April 3 to May 31, 2023.Receiving tenofovir disoproxil or entecavir as antiviral treatment for HBV.Primary end points were RFS and OS rates.Among 4451 patients (mean [SD] age, 58.1 [10.0] years; 3764 male [84.6%]; median [range] follow-up, of 51 [3 to 91] months), 989 patients in each of the groups were selected in propensity score matching. Baseline characteristics were comparable. In propensity score-matched groups, OS rates were 92.2% at 1 year, 70.9% at 3 years, and 54.2% at 5 years in the entecavir group, compared with 90.9% at 1 year, 75.2% at 3 years, and 64.0% at 5 years in the tenofovir disoproxil group. RFS rates were 83.9% at 1 year, 50.0% at 3 years, and 43.3% at 5 years in the entecavir group, compared with 85.3% at 1 year, 55.6% at 3 years, and 51.4% at 5 years in the tenofovir disoproxil group. Patients in the tenofovir disoproxil group had better OS (hazard ratio, 0.82; 95% CI, 0.72 to 0.94; P = .004) and RFS rates (hazard ratio, 0.81; 95% CI, 0.72 to 0.92; P = .001) compared with the entecavir group. Restricted mean survival time differences of entecavir vs tenofovir disoproxil groups were -0.05 (95% CI, -0.18 to 0.08) months at 1 year (P = .45), 0.20 (95% CI, -0.62 to 1.03) months at 3 years (P = .63), and 1.82 (95% CI, 0.14 to 3.51) months at 5 years (P = .03).These findings suggest that in patients undergoing curative liver resection for HBV-related HCC, tenofovir disoproxil was associated with better long-term OS and RFS rates compared with entecavir, providing insights for antiviral treatment.