Lin Bin, He Qiongxiao, Lu Yidan, Zhang Wanyi, Jin Jianwei, Pan Haiyan
Department of Emergency Medicine, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
Transl Cancer Res. 2023 Jun 30;12(6):1602-1616. doi: 10.21037/tcr-23-892. Epub 2023 Jun 26.
Whether viral hepatitis increases the risk of cholangiocarcinoma (CCA) has been controversial. The reasons for the differences between previous research results may be related to the differences in sample size, region, living environment and course of disease. A meta-analysis is needed to clarify the correlation between them and select the key population for early screening of CCA. Meta-analysis was used to explore the relationship between viral hepatitis and the risk of CCA, so as to provide evidence for the prevention and treatment of CCA.
We systematically searched EmBase, SinoMed, PubMed, Web of Science China National Knowledge Infrastructure, and Wanfang databases. The quality of the included literature was evaluated using the Newcastle Ottawa Scale. Before merging the effect quantities, the data was first subjected to heterogeneity testing. Heterogeneity testing was evaluated using I (the proportion of heterogeneity variation to overall variation). Subgroup analysis was used to identify sources of heterogeneity in this study. The effect odds ratio (OR) of various studies was extracted or calculated for consolidation. Beta's rank correlation, Egger's Law of Return and funnel plot were used to test publication bias. Conduct subgroup analysis based on the regions included in the literature.
A total of 2,113 articles were retrieved, and a total of 38 articles were included in the meta-analysis. There are 29 case-control studies and 9 Cohort study, including 333,836 cases and 4,042,509 controls. The combined risk estimate of all studies showed a statistically significant increased risk of CCA, extrahepatitis and intrahepatitis incidence with hepatitis B virus (HBV) infection (OR =1.75, OR =1.49, and OR =2.46, respectively). The combined risk estimate of all studies showed a statistically significant increased risk of CCA, extrahepatitis and intrahepatitis incidence with hepatitis C virus (HCV) infection (OR =1.45, OR =2.00, and OR =2.81, respectively). The research points of HCV and CCA were asymmetric, indicating that there may be publication bias in the study of HCV and CCA.
HBV and HCV infection could increase the risk of CCA. Therefore, in clinical practice, attention should be paid to CCA screening and early prevention of HBV and HCV infected patients.
病毒性肝炎是否会增加胆管癌（CCA）的发病风险一直存在争议。既往研究结果存在差异的原因可能与样本量、地区、生活环境及病程等不同有关。需要进行一项荟萃分析以阐明它们之间的相关性，并筛选出CCA早期筛查的重点人群。采用荟萃分析探讨病毒性肝炎与CCA发病风险的关系，为CCA的防治提供依据。
系统检索EmBase、中国生物医学文献数据库、PubMed、Web of Science、中国知网和万方数据库。采用纽卡斯尔-渥太华量表对纳入文献的质量进行评估。在合并效应量之前，首先对数据进行异质性检验。采用I²（异质性变异占总变异的比例）评估异质性检验。本研究采用亚组分析来识别异质性来源。提取或计算各项研究的效应比值比（OR）进行汇总。采用贝塔等级相关、埃格回归法和漏斗图检验发表偏倚。根据文献纳入的地区进行亚组分析。
共检索到2113篇文章，共38篇文章纳入荟萃分析。其中病例对照研究29项，队列研究9项，包括333836例病例和4042509例对照。所有研究的合并风险估计显示，感染乙型肝炎病毒（HBV）会使CCA、肝外和肝内发病率的风险显著增加（OR分别为1.75、1.49和2.46）。所有研究的合并风险估计显示，感染丙型肝炎病毒（HCV）会使CCA、肝外和肝内发病率的风险显著增加（OR分别为1.45、2.00和2.81）。HCV与CCA的研究点不对称，提示HCV与CCA的研究可能存在发表偏倚。
HBV和HCV感染会增加CCA发病风险。因此，在临床实践中，应重视对HBV和HCV感染患者进行CCA筛查及早期预防。
