Summary and Comment
Successful Treatment of HCV Infection Prevents Hepatocellular Carcinoma
Achieving sustained virologic response conferred a 76% reduced risk for developing hepatocellular carcinoma.
Patients with hepatitis C virus (HCV) infection who achieve sustained virologic response (SVR) from antiviral therapy seem to be at reduced risk for all-cause mortality (JW Gastroenterol Jan 11 2013) and possibly hepatocellular carcinoma (HCC), although studies of the latter have not established conclusive evidence of an association. The current meta-analysis aims to quantify the reduced risk for HCC while adjusting for known HCC risk factors.
Investigators conducted a comprehensive literature search for studies that compared outcomes of therapy-derived SVR with no response in patients treated for HCV infection. The quality of evidence was categorized as very low, low, moderate, or high based on a standard, validated grading system.
The search identified 30 studies comprising 31,528 participants from 17 countries. The average length of follow-up after treatment ranged from 2.5 to 14.4 years. In the 18 studies that provided adjusted effect estimates, 34.4% of patients achieved SVR, and 5.5% developed HCC. SVR was associated with reduced risk for HCC (adjusted relative risk, 0.24; P<0.001). The quality of evidence was moderate. For advanced liver disease, the findings were similar (ARR, 0.23; P<0.001), and evidence quality was also moderate. Adjustment for geographic location, varying confounders, and inclusion of unadjusted studies did not affect the results.
Comment: This well executed meta-analysis clearly demonstrates that achieving SVR protects against the development of hepatocellular carcinoma in HCV-infected people. Of note, this protective effect was independent of known confounders and stage of fibrosis. When newer, more effective, and better-tolerated HCV therapies become available, we can expect a further reduction in HCC incidence in HCV-infected people.
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology March 22, 2013
Citation(s):
Morgan RL et al. Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: A meta-analysis of observational studies. Ann Intern Med 2013 Mar 5; 158:329. (http://annals.org/article.aspx?articleid=1657880)
搜索确定了30项研究，包括31,528名来自17个国家。治疗后随访的平均长度范围从2.5到14.4岁。调整后的效果估计在18项研究中，有34.4％的患者获得SVR，5.5％发展成肝癌。 SVR与降低肝癌的风险（调整后的相对危险度，0.24; P <0.001）。证据的质量是温和的。对于先进的肝脏疾病，调查结果相似（ARR，0.23，P <0.001），和，证据质量也适中。调整的地理位置，不同的混杂因素，包括未经调整的研究并没有影响到结果。