Lui Felix H, Moosvi Zain, Patel Anish, Hussain Samiya, Duong Alex, Duong Jacqueline, Nguyen Douglas L
Department of Gastroenterology and Hepatology (Felix H. Lui, Alex Duong, Jacqueline Duong, Douglas L. Nguyen).
Department of Internal Medicine (Zain Moosvi, Anish Patel, Samiya Hussain), University of California-Irvine, Orange, CA, USA.
Ann Gastroenterol. 2020 May-Jun;33(3):293-298. doi: 10.20524/aog.2020.0470. Epub 2020 Mar 27.
Studies investigating the association between direct-acting antivirals (DAAs) and the recurrence of hepatocellular carcinoma (HCC) related to hepatitis C (HCV) have yielded conflicting results. The objective of this meta-analysis was to define the short- and long-term recurrence rates of HCC after DAA treatment.
A search of multiple databases was performed, including Scopus, Cochrane, MEDLINE/PubMed and abstracts from gastroenterology meetings. Only studies reporting the recurrence of HCC in patients receiving DAA treatment, compared to HCV controls without DAA treatment, were evaluated. A meta-analysis was completed using the Mantel-Haenszel model.
A comprehensive literature search resulted in 32 abstracts and papers. Six papers met our inclusion criteria and were included in the analysis. Follow up ranged from 1.25-4 years. Analysis of these 6 studies found a >60% lower risk of HCC recurrence in patients exposed to DAA compared to controls (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.27-0.47; P<0.001; =88%). A sensitivity analysis, which excluded studies showing the lowest recurrence rate to reduce heterogeneity, showed that patients receiving DAA still had a 60% lower risk of developing HCC (OR 0.4, 95%CI 0.26-0.61; P<0.0001; =39%) and a 66% lower risk of developing HCC beyond 1 year (OR 0.34, 95%CI 0.22-0.54; P<0.00001; =0%) compared to controls.
The use of DAA is associated with a significantly lower risk of HCC development compared to DAA-untreated patients, both overall and beyond 1 year of treatment. Further studies are needed to assess the impact of DAAs on early recurrence.
关于直接作用抗病毒药物（DAA）与丙型肝炎（HCV）相关肝细胞癌（HCC）复发之间关联的研究结果相互矛盾。本荟萃分析的目的是确定DAA治疗后HCC的短期和长期复发率。
对多个数据库进行了检索，包括Scopus、Cochrane、MEDLINE/PubMed以及胃肠病学会议的摘要。仅评估了报告接受DAA治疗的患者中HCC复发情况并与未接受DAA治疗的HCV对照进行比较的研究。使用Mantel-Haenszel模型完成了荟萃分析。
全面的文献检索得到了32篇摘要和论文。6篇论文符合我们的纳入标准并被纳入分析。随访时间为1.25至4年。对这6项研究的分析发现，与对照组相比，接受DAA治疗的患者HCC复发风险降低了60%以上（优势比[OR]0.36，95%置信区间[CI]0.27 - 0.47；P<0.001；I² = 88%）。一项敏感性分析排除了显示最低复发率的研究以减少异质性，结果表明接受DAA治疗的患者发生HCC的风险仍比对照组低60%（OR 0.4，95%CI 0.26 - 0.61；P<0.0001；I² = 39%），且在治疗1年后发生HCC的风险比对照组低66%（OR 0.34，95%CI 0.22 - 0.54；P<0.00001；I² = 0%）。
与未接受DAA治疗的患者相比，使用DAA总体上以及在治疗1年后发生HCC的风险均显著降低。需要进一步研究来评估DAA对早期复发的影响。
