Carvedilol versus Propranolol in Patients with Hepatocellular Carcinoma: A Nationwide Cohort Study.

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.