Quantitative Surface Antigen and E Antigen in Children with Chronic Hepatitis B: Results from the Pediatric Cohort Study of the Niddk-Sponsored Hepatitis B Research Network (HBRN)

size (5.9 vs. 4.9 cm); higher prevalence of multifocal tumors (53% vs. 46%), vascular invasion (29% vs. 21%), and extrahepatic metastasis (13% vs. 8%); and higher Barcelona clinic liver cancer stage (BCLC; 42% vs. 28% stage C/D); p < 0.01 for all comparisons.Patients not receiving antiviral therapy were less likely to undergo cancer-directed treatment than those receiving antiviral therapy (78% vs. 89%; p < 0.001) and this difference extended across most treatment types.Treatment with antiviral medications was associated with increased survival, and this difference persisted across tumor stage, degree of liver disease, and treatment modality (Table 1).In a multivariate model inclusive of age, sex, cirrhosis, MELD, BCLC, treatment type, and site, antiviral therapy remained associated with decreased mortality (HR 0.66, 95% CI 0.58-0.76,p < 0.001).Conclusions: Antiviral therapy is associated with improved survival in HBV-related HCC, independent of other predictors of survival.Many patients for whom antiviral therapy was indicated were not on antiviral therapy at time of HCC diagnosis.Expanded use of antiviral therapy before and after HCC diagnosis may improve patient outcomes.