Department of Gastroenterology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, 43 People's Avenue, Haikou, 570028, China.
Department of Gastroenterology, Zhongshan Hospital of Fudan University, 180 Fenglin Rd., Shanghai, 200032, China.
Dig Dis Sci. 2018 Dec;63(12):3207-3219. doi: 10.1007/s10620-018-5252-8. Epub 2018 Aug 23.
The efficacy of nucleoside analogs (NAs) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after curative treatment remains unclear. The present study aimed to evaluate the efficacy of these agents by conducting a comprehensive meta-analysis of available studies.
We searched several databases including Pubmed, Embase, Cochrane Library, Clinical Trials, and Web of Science, according to PRISMA guidelines. We considered all randomized controlled trials and cohort studies that met the inclusion criteria. Statistical analyses were conducted using Review Manager 5.3 and Stata 14.0.
Twenty-one studies with 8752 participants were included in the final analysis. The pooled data showed that patients treated with NAs had significantly lower 1- and 3-year HCC recurrence rates (relative risk [RR] 0.76, 95% confidence interval [CI] 0.65-0.90; P = 0.001 and RR 0.79, 95% CI 0.71-0.88; P < 0.001, respectively), but there was no difference in 5-year recurrence rates (RR 0.87, 95% CI 0.74-1.03; P = 0.10). Regarding overall survival (OS), patients treated with NAs had significantly higher 1-, 3-, and 5-year OS rates (RR 1.05, 95% CI 1.02-1.08; P = 0.003; RR 1.25, 95% CI 1.16-1.34; P < 0.001; and RR 1.28, 95% CI 1.18-1.39; P < 0.001, respectively).
NA therapy has the potential to reduce the risk of early recurrence and improve OS in patients with HBV-related HCC after curative treatment, compared with placebo or no treatment. Further research including more homogeneous studies with large sample sizes is required to improve the reliability of these conclusions.
核苷（酸）类似物（NAs）在根治性治疗后治疗乙型肝炎病毒（HBV）相关肝细胞癌（HCC）的疗效仍不清楚。本研究旨在通过对现有研究进行全面的荟萃分析来评估这些药物的疗效。
根据 PRISMA 指南，我们检索了包括 Pubmed、Embase、Cochrane 图书馆、临床试验和 Web of Science 在内的多个数据库。我们考虑了所有符合纳入标准的随机对照试验和队列研究。使用 Review Manager 5.3 和 Stata 14.0 进行统计分析。
最终分析纳入了 21 项研究，共 8752 名参与者。汇总数据显示，接受 NAs 治疗的患者 1 年和 3 年 HCC 复发率显著降低（相对风险 [RR] 0.76，95%置信区间 [CI] 0.65-0.90；P=0.001 和 RR 0.79，95% CI 0.71-0.88；P<0.001），但 5 年复发率无差异（RR 0.87，95% CI 0.74-1.03；P=0.10）。关于总生存（OS），接受 NAs 治疗的患者 1 年、3 年和 5 年 OS 率显著提高（RR 1.05，95% CI 1.02-1.08；P=0.003；RR 1.25，95% CI 1.16-1.34；P<0.001；和 RR 1.28，95% CI 1.18-1.39；P<0.001）。
与安慰剂或不治疗相比，NA 治疗有可能降低 HBV 相关 HCC 根治性治疗后患者的早期复发风险并改善 OS。需要进一步进行包括更多同质研究和大样本量的研究，以提高这些结论的可靠性。
