Department of Hepatology, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China.
Department of Urology, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, China.
J Viral Hepat. 2021 Feb;28(2):226-235. doi: 10.1111/jvh.13434. Epub 2020 Nov 18.
Although some epidemiological studies have investigated the association between Hepatitis C virus (HCV) infection and the development of kidney cancer, the results are far from consistent. We conducted a systematic review and meta-analysis of observational studies to determine the association. PubMed, EMBASE and Cochrane database were searched from 1 January 1975 to 7 January 2020. Study selection, data extraction and bias assessment (using the Newcastle-Ottawa scale) were performed independently by 2 authors. Pooled odds ratios (ORs) with corresponding confidence intervals (CIs) were calculated using a random-effects model. In all, 16 studies (11 cohort studies and 5 case-control studies) involving a total of 391,071 HCV patients and 38,333,839 non-HCV controls were included. The overall analysis showed a 47% higher risk to develop kidney cancer among the patients with HCV infection (pooled OR 1.47; 95% CI 1.14-1.91), despite significant heterogeneity (I = 87.6%). The multivariable meta-regression showed that study design, age, sample size and HIV co-infection were significant sources of variance, and totally accounted for 82% of the I . The risk of KC in HCV patients was further increased in studies without HCV/HBV- and HCV/HIV- co-infection (pooled OR 1.66; 95%CI 1.23-2.24). Multiple sensitivity analyses did not change the significant association. The present meta-analysis indicated that HCV-infected patients have a significantly higher risk of developing kidney cancer. Our results highlighted the rationale for improved renal surveillance in HCV patients for the early diagnosis of kidney cancer. Further investigations for the mechanisms underlying HCV-induced kidney cancer are warranted.
虽然一些流行病学研究已经调查了丙型肝炎病毒 (HCV) 感染与肾癌发展之间的关系，但结果远不一致。我们对观察性研究进行了系统评价和荟萃分析以确定相关性。从 1975 年 1 月 1 日至 2020 年 1 月 7 日，我们在 PubMed、EMBASE 和 Cochrane 数据库中进行了检索。两位作者独立进行了研究选择、数据提取和偏倚评估（使用纽卡斯尔-渥太华量表）。使用随机效应模型计算了汇总比值比 (OR) 和相应的置信区间 (CI)。共纳入 16 项研究（11 项队列研究和 5 项病例对照研究），共纳入 391071 例 HCV 患者和 38333839 例非 HCV 对照。总体分析显示，HCV 感染患者发生肾癌的风险增加了 47%（汇总 OR 1.47；95%CI 1.14-1.91），尽管存在显著异质性（I = 87.6%）。多变量荟萃回归显示，研究设计、年龄、样本量和 HIV 合并感染是变异的重要来源，共占 I 的 82%。在没有 HCV/HBV-和 HCV/HIV-合并感染的研究中，HCV 患者发生 KC 的风险进一步增加（汇总 OR 1.66；95%CI 1.23-2.24）。多项敏感性分析并未改变显著相关性。本荟萃分析表明，HCV 感染患者发生肾癌的风险显著增加。我们的结果强调了对 HCV 患者进行肾脏监测以早期诊断肾癌的合理性。需要进一步研究 HCV 诱导肾癌的机制。
