Section of Gastroenterology and Hepatology and Clinical Epidemiology and Comparative Effectiveness Program in the Health Services Research, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe Blvd (MS152), Houston, TX, 77030, USA.
Clinical Epidemiology and Comparative Effectiveness Program, Section of Health Services Research (IQuESt), Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2021 Jul;66(7):2439-2451. doi: 10.1007/s10620-020-06498-7. Epub 2020 Aug 2.
The risk and determinants of HCC in patients with primary biliary cholangitis (PBC) are unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and risk factors associated with HCC risk among patients with PBC.
We searched PubMed, EMBASE, MEDLINE, Cochrane databases and reference lists from relevant articles to identify cohort studies that examined incidence of HCC in patients with PBC from inception through November 2019.
A total of 29 studies including 22,615 patients met the eligibility criteria. The median cohort size was 292 patients followed for an average of 76 months. The pooled incidence rate for patients with PBC was 4.17 per 1000 patient-years (95% CI 3.17-5.47). On subgroup analysis, the incidence of HCC in patients with PBC cirrhosis was 15.7 per 1000 patient-years (95% CI 8.73-28.24). The HCC incidence rate was 9.82 per 1000 person-years (95% CI 5.92-16.28) in men and 3.82 per 1000 person-years (95% CI 2.85-5.11) in women.
Cirrhosis is the strongest risk factor for HCC in patients with PBC. Male gender was also a risk factor. Our meta-analysis supports current recommendations of HCC surveillance in patients with PBC cirrhosis. Further studies are needed to evaluate risk factors in this population.
原发性胆汁性胆管炎（PBC）患者发生 HCC 的风险和决定因素尚不清楚。我们对 PBC 患者 HCC 发生率和与 HCC 风险相关的危险因素进行了系统评价和荟萃分析。
我们检索了 PubMed、EMBASE、MEDLINE、Cochrane 数据库和相关文章的参考文献列表，以确定从发病到 2019 年 11 月期间检查 PBC 患者 HCC 发生率的队列研究。
共有 29 项研究符合纳入标准，共纳入 22615 例患者。队列的中位规模为 292 例，平均随访 76 个月。PBC 患者的汇总发生率为每 1000 人年 4.17 例（95%CI 3.17-5.47）。亚组分析显示，PBC 肝硬化患者的 HCC 发生率为每 1000 人年 15.7 例（95%CI 8.73-28.24）。男性 HCC 发生率为每 1000 人年 9.82 例（95%CI 5.92-16.28），女性为每 1000 人年 3.82 例（95%CI 2.85-5.11）。
肝硬化是 PBC 患者发生 HCC 的最强危险因素。男性也是一个危险因素。我们的荟萃分析支持目前对 PBC 肝硬化患者进行 HCC 监测的建议。需要进一步研究来评估该人群的危险因素。
