The effect of propranolol on the prognosis of hepatocellular carcinoma: A nationwide population-based study

PLoS One. 2019 May 24;14(5):e0216828. doi: 10.1371/journal.pone.0216828. eCollection 2019.

Abstract

Background: Beta-blockers can reduce recurrence, metastasis, and mortality in various cancers. In this study, we investigated the effect of propranolol, a non-selective beta-blocker on overall survival (OS) in unresectable/metastatic hepatocellular carcinoma (HCC) and on recurrence-free survival (RFS) in resectable, curable HCC.

Methods: Data were retrieved from the Taiwan National Health Insurance Research Database between January 2000 and December 2013. Propranolol users (for >1 year) and non-propranolol users were matched using a 1:2 propensity score in both cohorts.

Results: The unresectable/metastatic HCC cohort comprised 1,560 propranolol users and 3,120 non-propranolol users (control group). On multivariate Cox regression analysis of HCC mortality, propranolol significantly reduced the mortality risk by 22% (hazard ratio [HR] = 0.78, 95% confidence interval [CI] 0.72-0.84, P <0.001). On stratified Cox regression analysis, propranolol also reduced the mortality risk in HCC patients with hepatitis B (HR = 0.92, 95% CI 0.85-0.99, P = 0.045), hepatitis C (HR = 0.85, 95% CI = 0.78-0.92, P = 0.001), liver cirrhosis (HR = 0.78, 95% CI = 0.72-0.85, P <0.001), and diabetes mellitus (HR = 0.87, 95% CI = 0.81-0.94, P = 0.008). The resectable, curable HCC cohort comprised 289 propranolol users and 578 non-propranolol users (control group), but there was no significant difference in RFS (P = 0.762) between propranolol and non-propranolol users.

Conclusion: This study revealed that propranolol could improve OS in unresectable/metastatic HCC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular* / mortality
  • Carcinoma, Hepatocellular* / therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Liver Neoplasms* / mortality
  • Liver Neoplasms* / therapy
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Proportional Hazards Models
  • Propranolol / administration & dosage*
  • Survival Rate
  • Taiwan / epidemiology

Substances

  • Propranolol

Grants and funding

This study was supported by grants from Tri-Service General Hospital Research Foundation (TSGH-C108-003 to W-CC), and the sponsor has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.