Li Chien-Feng, Tsao Shih-Ming, Liao Hsien-Hua, Chen Shiuan-Chih, Lee Yuan-Ti
School of Medicine, Chung Shan Medical University.
Division of Infectious Diseases, Department of Internal Medicine.
Medicine (Baltimore). 2020 Oct 2;99(40):e22435. doi: 10.1097/MD.0000000000022435.
Given that evidence supporting chronic hepatitis C (CHC) infection developed chance for hepatocellular carcinoma (HCC) following antiviral agents therapy is controversial. We conducted a meta-analysis to examine the risk.We evaluated 20 retrospective and prospective cohort studies published up to 31 December 2017 which investigated the association between sustained virological response (SVR) and incidence of HCC patients treated with monotherapy interferon (IFN) or IFN plus ribavirin (RBV) therapy. The primary outcome of the study was the cumulative incidence of HCC. Odds ratio (OR) was used to evaluate the index of effect size for the association between SVR and treatment with IFN alone or IFN/RBV in CHC patients.SVR patients demonstrated a lower incidence of HCC compared to non-SVR patients. Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN plus RBV (pooled OR = 7.405, 95% CI = 4.689 to 11.694, P < .001). Non-SVR patients had greater odds of HCC incidence compared to SVR patients in the treatment of IFN monotherapy (pooled OR = 4.135, 95% CI = 3.009 to 5.682, P < .001). Lack of SVR to IFN therapy was significantly associated with greater risk of HCC incidence (pooled OR = 5.035, 95% CI = 3.915 to 6.474, P < .001).SVR could be as a predictor of HCC in CHC patients treated with IFN or IFN plus RBV, and have important implications during HCC screening, whereby patients who fail to achieve SVR need to be screened more rigorously.
鉴于支持慢性丙型肝炎(CHC)感染患者在接受抗病毒药物治疗后发生肝细胞癌(HCC)的证据存在争议。我们进行了一项荟萃分析以研究该风险。我们评估了截至2017年12月31日发表的20项回顾性和前瞻性队列研究,这些研究调查了持续病毒学应答(SVR)与接受单药干扰素(IFN)或IFN联合利巴韦林(RBV)治疗的HCC患者发病率之间的关联。该研究的主要结局是HCC的累积发病率。比值比(OR)用于评估CHC患者中SVR与单独使用IFN或IFN/RBV治疗之间关联的效应大小指标。与非SVR患者相比,SVR患者的HCC发病率较低。在IFN联合RBV治疗中,非SVR患者发生HCC的几率高于SVR患者(合并OR = 7.405,95%CI = 4.689至11.694,P <.001)。在IFN单药治疗中,非SVR患者发生HCC的几率高于SVR患者(合并OR = 4.135,95%CI = 3.009至5.682,P <.001)。IFN治疗缺乏SVR与HCC发病风险增加显著相关(合并OR = 5.035,95%CI = 3.915至6.474,P <.001)。SVR可作为接受IFN或IFN联合RBV治疗的CHC患者HCC的预测指标,并且在HCC筛查中具有重要意义,即未实现SVR的患者需要更严格地进行筛查。