Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA.
Clin Gastroenterol Hepatol. 2010 Feb;8(2):192-9. doi: 10.1016/j.cgh.2009.10.026. Epub 2009 Oct 30.
BACKGROUND & AIMS: The effects of antiviral therapy on prevention of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related cirrhosis are unclear. We performed a systematic review and meta-analysis to assess HCC risk reduction in patients with HCV-related cirrhosis who have received antiviral therapy.
Twenty studies (4700 patients) were analyzed that compared untreated patients with those given interferon (IFN) alone or ribavirin. Risk ratios (RRs) determined effect size using a random effects model.
Pooled data showed reduced HCC risk in the treatment group (RR, 0.43; 95% confidence interval [CI], 0.33-0.56), although the data were heterogenous (chi(2) = 59.10). Meta-regression analysis showed that studies with follow-up durations of more than 5 years contributed to heterogeneity. Analysis of 14 studies (n = 3310) reporting sustained virologic response (SVR) rates with antiviral treatment showed reduced HCC risk in patients with an SVR, compared with nonresponders (RR, 0.35; 95% CI, 0.26-0.46); the maximum benefits were observed in patients treated with ribavirin-based regimens (RR, 0.25; 95% CI, 0.14-0.46). Meta-analysis of 4 studies assessing the role of maintenance IFN in nonresponders did not show HCC risk reduction (RR, 0.58; 95% CI, 0.33-1.03). No publication bias was detected by the Egger test analysis (P > 0.1).
The risk of HCC is reduced among patients with HCV who achieve an SVR with antiviral therapy. Maintenance therapy with IFN does not reduce HCC risk among patients who do not respond to initial therapy. View this article's video abstract atwww.cghjournal.org.
抗病毒治疗对预防丙型肝炎病毒（HCV）相关肝硬化患者肝细胞癌（HCC）的作用尚不清楚。我们进行了一项系统评价和荟萃分析，以评估接受抗病毒治疗的 HCV 相关肝硬化患者 HCC 风险的降低。
分析了 20 项研究（4700 例患者），比较了未治疗患者与单独使用干扰素（IFN）或利巴韦林治疗的患者。使用随机效应模型，风险比（RR）确定效应量。
汇总数据显示治疗组 HCC 风险降低（RR，0.43；95%置信区间[CI]，0.33-0.56），尽管数据存在异质性（chi(2) = 59.10）。Meta 回归分析表明，随访时间超过 5 年的研究导致了异质性。对 14 项（n = 3310）报告抗病毒治疗持续病毒学应答（SVR）率的研究进行分析显示，与无应答者相比，SVR 患者 HCC 风险降低（RR，0.35；95%CI，0.26-0.46）；在接受基于利巴韦林的方案治疗的患者中，获益最大（RR，0.25；95%CI，0.14-0.46）。对 4 项评估非应答者维持 IFN 作用的研究进行的荟萃分析并未显示 HCC 风险降低（RR，0.58；95%CI，0.33-1.03）。Egger 检验分析未发现发表偏倚（P > 0.1）。
接受抗病毒治疗达到 SVR 的 HCV 患者 HCC 风险降低。对初始治疗无应答的患者，维持 IFN 治疗不能降低 HCC 风险。在 www.cghjournal.org 观看本文的视频摘要。
