Kim Nicole J, Vutien Philip, Cleveland Erin, Cravero Anne, Ioannou George N
Division of Gastroenterology, University of Washington, Seattle, Washington.
Division of Gastroenterology, University of Washington, Seattle, Washington.
Clin Gastroenterol Hepatol. 2023 Jul;21(7):1723-1738.e5. doi: 10.1016/j.cgh.2022.04.013. Epub 2022 May 5.
BACKGROUND & AIMS: Hepatitis C virus (HCV) eradication with direct-acting antivirals reduces hepatocellular carcinoma (HCC) risk. Pooled HCC incidence rates by cirrhosis status and fibrosis stage have not been estimated using meta-analysis.
We searched PubMed, Web of Science, Embase, and Cochrane Library from January 1, 2014 to December 31, 2020 to identify studies assessing HCC incidence or outcomes by cirrhosis status, in adults with HCV who achieved sustained virologic response (SVR) after direct-acting antivirals. Pooled estimates were obtained using random-effects modeling. Subgroup, sensitivity, and meta-regression analyses were performed to evaluate heterogeneity.
We included 31 studies involving 27,711 patients with cirrhosis (mean follow-up, 2.1 years) and 11 studies involving 32,123 patients without cirrhosis (mean follow-up, 2.6 years). HCC incidence was 2.99/100 person-years (95% confidence interval [CI], 2.52-3.54; I = 75%) in patients with cirrhosis, 0.47/100 person-years (95% CI, 0.32-0.70, I = 71%) in patients without cirrhosis, and 0.63/100 person-years (95% CI: 0.34-1.20, I = 0%) in stage 3 (F3) fibrosis. Among patients with cirrhosis, HCC incidence was highest in studies with <1 year of follow-up (6.17/100 person-years [95% CI, 3.73-10.19]) and progressively lower in studies with longer follow-up (1-2 years: 2.75/100 person-years [95% CI, 2.48-3.06]; 2-3 years: 2.90/100 person-years [95% CI, 1.90-4.44]; ≥3 years: 1.83/100 person-years [95% CI, 0.88-3.80]).
Pooled HCC incidence after SVR in patients with cirrhosis was very high (2.99/100 person-years) but may be declining as longer time accrues after SVR. In patients without cirrhosis, including F3 fibrosis, HCC incidence was lower than thresholds associated with cost-effective HCC screening. In patients with F3 fibrosis, the lack of between-study heterogeneity provides strong evidence that HCC screening may not be warranted.
使用直接抗病毒药物清除丙型肝炎病毒（HCV）可降低肝细胞癌（HCC）风险。尚未通过荟萃分析估计按肝硬化状态和纤维化阶段汇总的HCC发病率。
我们检索了2014年1月1日至2020年12月31日期间的PubMed、Web of Science、Embase和Cochrane图书馆，以识别评估在接受直接抗病毒药物治疗后实现持续病毒学应答（SVR）的HCV成年患者中，按肝硬化状态划分的HCC发病率或转归的研究。使用随机效应模型获得汇总估计值。进行亚组分析、敏感性分析和meta回归分析以评估异质性。
我们纳入了31项研究，涉及27711例肝硬化患者（平均随访2.1年）和11项研究，涉及32123例无肝硬化患者（平均随访2.6年）。肝硬化患者的HCC发病率为2.99/100人年（95%置信区间[CI]，2.52 - 3.54；I² = 75%），无肝硬化患者为0.47/100人年（95%CI，0.32 - 0.70，I² = 71%），3期（F3）纤维化患者为0.63/100人年（95%CI：0.34 - 1.20，I² = 0%）。在肝硬化患者中，随访时间<1年的研究中HCC发病率最高（6.17/100人年[95%CI，3.73 - 10.19]），随访时间较长的研究中发病率逐渐降低（1 - 2年：2.75/100人年[95%CI，2.48 - 3.06]；2 - 3年：2.90/100人年[95%CI，1.90 - 4.44]；≥3年：1.83/100人年[95%CI，0.88 - 3.80]）。
肝硬化患者SVR后的汇总HCC发病率非常高（2.99/100人年），但可能随着SVR后时间的延长而下降。在无肝硬化患者中，包括F3纤维化患者，HCC发病率低于与具有成本效益的HCC筛查相关的阈值。在F3纤维化患者中，研究间缺乏异质性提供了强有力的证据，表明可能无需进行HCC筛查。
