成功治疗丙型肝炎病毒感染预防肝癌

StephenW

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)

Medline abstract (Free)

StephenW

述评
成功治疗丙型肝炎病毒感染的预防肝癌

实现持续的病毒学应答赋予了76％的风险降低肝癌发展。

丙型肝炎病毒（HCV）感染，达到持续病毒学应答（SVR）抗病毒治疗的患者似乎是在降低风险的各种原因的死亡率“（JW胃肠病学杂志2013年1月11日）和可能肝细胞癌（HCC）的研究，虽然后者没有建立关联的证据确凿。目前的荟萃分析的目的是量化的降低肝癌的风险而调整已知的HCC危险因素。

调查进行了全面的文献检索的研究，比较的结果治疗衍生SVR的治疗丙型肝炎病毒感染的患者没有反应。被列为证据的质量非常低，低，中等，或高标准的基础上，经过验证的分级制度。

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。

点评：这很好地执行的荟萃分析清楚地表明，实现SVR防止HCV感染者肝癌的发展。值得注意的是，这种保护作用是已知的干扰因素和纤维化分期无关。当新的，更有效，更好的耐受性丙型肝炎的治疗变得可用，我们可以预期在丙型肝炎病毒感染的人肝癌发病率进一步降低。

-  ATIF扎曼，MD，MPH

观察胃肠病学杂志2013年3月22日发布

参考文献（S）：

摩根RL等人。 C型肝炎病毒感染与肝癌的发展根除的观察性研究的Meta分析。安内科杂志2013年3月5日; 158:329。 （http://annals.org/article.aspx?articleid=1657880）

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