Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2024 Sep;30(Suppl):S172-S185. doi: 10.3350/cmh.2024.0262. Epub 2024 Aug 12.
BACKGROUNDS/AIMS: Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR.
We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies' methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models.
We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2-13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4-11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa.
VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact.
背景/目的：尽管抗病毒疗法在治疗丙型肝炎病毒（HCV）感染方面取得了进展，但在晚期纤维化或肝硬化患者中，即使获得持续病毒学应答（SVR），仍会发展为肝细胞癌（HCC）。本荟萃分析研究了振动控制瞬时弹性成像（VCTE）和纤维化 4 指数（FIB-4）在 SVR 后预测 HCC 发生的性能。
我们检索了 PubMed、MEDLINE、EMBASE 和 Cochrane 图书馆中关于这些检测方法在 HCV 成年患者中的预测性能的研究。两位作者独立筛选研究的方法学质量并提取数据。使用随机效应二变量逻辑正态和线性混合效应模型，计算 VCTE 和 FIB-4 用于 HCC 发展的敏感性、特异性和曲线下面积（AUC）的合并估计值。
我们纳入了 27 项研究（169911 名患者）。对 SVR 后 HCC 进行的 Meta 分析在 9 项 VCTE 和 15 项 FIB-4 研究中是可行的。关于 SVR 后 HCC 发展的预测，VCTE >9.2-13 kPa 和 FIB-4 >3.25 的预治疗 AUC 分别为 0.79 和 0.73。SVR 后测量的 VCTE >8.4-11 kPa 和 FIB-4 >3.25 保持了良好的预测性能，尽管略有降低（合并 AUC：分别为 0.77 和 0.70）。用于预测 SVR 后 HCC 发展的最佳临界值为 VCTE 预治疗时的 12.6 kPa，SVR 后 VCTE 测量时为 11.2 kPa。
VCTE 和 FIB-4 对 HCV 患者获得 SVR 后 HCC 的发生具有可接受的预测性能，突出了它们在指导监测策略方面的临床实用性。需要进一步的前瞻性研究来验证这些发现并验证其临床影响。
