Carvedilol versus Propranolol in Patients with Hepatocellular Carcinoma: A Nationwide Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: Beta-blockers reduce portal hypertension; however, evidence comparing carvedilol and propranolol in patients with hepatocellular carcinoma (HCC) is lacking. We aimed to compare the clinical outcomes of carvedilol versus propranolol in patients with HCC. Methods: Using the Korean National Health Insurance Service database (2009–2023), we identified 11,124 patients with newly diagnosed HCC who were prescribed either carvedilol (n = 2,457) or propranolol (n = 8,667) within 180 days of diagnosis. The primary outcome was all-cause mortality, and the secondary outcome was hepatic decompensation. Multivariable Cox regression and 1:2 PS matching were used as primary analytical approaches, with sensitivity analyses restricted to 6-month survivors and a new-user design. Results: During a median follow-up of 1.5 years, carvedilol use was associated with a significantly lower risk of hepatic decompensation (adjusted hazard ratio [aHR] 0.67; 95% confidence interval [CI] 0.62–0.72) and all-cause mortality (aHR 0.84; 95% CI 0.79–0.90) compared to propranolol. In the 1:2 PS-matched cohort (n = 5,922), these associations remained consistent for both decompensation (HR 0.68; 95% CI 0.63–0.74) and mortality (HR 0.84; 95% CI 0.78–0.90). These benefits were consistent across various subgroups, and in sensitivity analysis excluding early death within 6 months from diagnosis and using a new-user design. Conclusion: In patients with HCC, carvedilol was associated with better survival and lower risk of hepatic decompensation than propranolol. Carvedilol may be the preferred beta-blocker over propranolol in the setting of HCC.
Source: Liver Cancer
DOI: 10.1159/000553325
Institutions: Samsung Medical Center, Sungkyunkwan University
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,590
OpenAlex ID: W7166559323
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