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Comment & Response
April 25, 2019

Lower Risk of Hepatocellular Carcinoma With Tenofovir vs Entecavir in Patients With Chronic Hepatitis B—in Reply

Author Affiliations
  • 1Liver Center, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
  • 2Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Jung-gu, Seoul, Republic of Korea
JAMA Oncol. 2019;5(6):916-917. doi:10.1001/jamaoncol.2019.0650

In Reply We are thankful for the letters addressing our article.1 The letter from Zhang and Zeng voiced the importance of family history in the risk of hepatocellular carcinoma (HCC). However, family history of a cancer by self-reported data may be prone to recall bias, and its completeness and accuracy are greatly influenced by the patients’ age at the time of the interview and educational level.2 Furthermore, because the majority of patients with chronic hepatitis B in many Asian countries acquire hepatitis B virus (HBV) infection through vertical transmission at the neonatal period, and the risk of HCC progressively increases with increasing age, family history of HCC may be greatly influenced by birth order of the patients among siblings. Considering these potential measurement biases, we included only objective covariates for the analysis of risk factors for HCC in our study.

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