非选择性β受体阻滞剂可降低肝癌的风险：荟萃分析随机试

StephenW

Non-selective beta-blockers may reduce risk of hepatocellular carcinoma: a meta-analysis of randomised trials

    Maja Thiele1,*,
    Agustín Albillos2,
    Rozeta Abazi1,
    Reiner Wiest3,
    Lise L. Gluud4 and
    Aleksander Krag1

DOI: 10.1111/liv.12782

Vol. 35 Issue 1
Liver International

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)


Author Information

    1    Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
    2    Department of Gastroenterology and Hepatology, University Hospital Ramón y Cajal, University of Alcalá, IRYCIS, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institute of Health Carlos III, Madrid, Spain
    3    Department for Visceral Surgery and Medicine, University Hospital Bern, Switzerland
    4    Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

*Corresponding author: M. Thiele, Department of Gastroenterology and Hepatology, Odense University Hospital, Sdr. Boulevard 29, entrance 128, DK-5000 Odense, Denmark. Phone: +4565412752. Email: [email protected]

    This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.12782


Abstract
Background & aims

Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomised trials.
Methods

Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I2 as a measure of heterogeneity. Subgroup, sensitivity, regression, and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing.
Results

Twenty-three randomised trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC versus 65 of 697 controls (risk difference -0.026; 95% confidence interval -0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I2 = 7%) or evidence of small-study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC related mortality (RD -0.011; 95% CI -0.040 to 0.017).
Conclusions

NSBB may prevent HCC in patients with cirrhosis..

This article is protected by copyright. All rights reserved.

StephenW

非选择性β受体阻滞剂可降低肝癌的风险：荟萃分析随机试验

    玛雅Thiele1，*，
    阿古斯丁Albillos2，
    Rozeta Abazi1，
    莱纳Wiest3，
    莉莎L. Gluud4和
    亚历山大·Krag1

DOI：10.1111/ liv.12782

第一卷。 35第1期
肝国际

接受第（接受，未经编辑的文章在网上和引述的公布，最终编辑和记录排版本将出现在未来。）


作者信息

    胃肠病学和肝病，欧登塞大学医院，欧登塞，丹麦1系
    胃肠病学和肝病，大学医院拉蒙·卡哈尔Ÿ，阿尔卡拉，IRYCIS，大学2系炫酷德InvestigaciónBIOMEDICA恩红恩EnfermedadesHepáticasŸDigestivas（CIBERehd），卫生卡洛斯三世研究所，西班牙马德里
    3部内脏手术和医学大学医院瑞士伯尔尼
    4 Gastrounit，哥本哈根大学医院哈维德夫，哈维德夫，丹麦

*通讯作者：M.蒂勒，胃肠病学和肝病，欧登塞大学医院，SDR系。大道29，高考128，DK-5000欧登塞，丹麦。电话：4565412752。电子邮件：[email protected]

    这篇文章已被接受发表，并接受全面的同行评审，但经过审稿，排版，分页和校对过程中，这可能会导致这个版本和记录的版本之间的差异一直没有。请引用这篇文章的DOI：10.1111/ liv.12782


抽象
背景及目的

非选择性β受体阻滞剂（NSBB）用于治疗肝硬化食管静脉曲张。实验数据表明，NSBB抑制血管生成，并减少细菌移位，这可能会阻止肝细胞癌（HCC）。因此，我们评估NSBB对肝癌效果通过执行与随机试验的荟萃分析系统的审查。
方法：

电子和人工搜索相结合。作者进行了接触的未发表的数据。纳入试验评估NSBB的肝硬化患者;对照组可以得到比NSBB其他任何干预。固定和随机效应荟萃分析，与I2为异质性的措施执行。子群，灵敏度，回归，和顺序分析来评价异质性，偏差和的结果调整多个测试后的坚固性。
结果

两三对2618例肝硬化患者随机试验都包括在内，其中12日报道HCC发生率和23日报道肝癌死亡率。随访的平均持续时间为26个月（8-82）。总体而言，694例患者随机接受NSBB47开发HCC比65的697控件（风险差-0.026;95％的置信区间为-0.052-0.001;治疗38例需要的数量）。没有异质性（I2=7％）或小的影响研究（埃格斯P =0.402）的证据。其结果是不连续的分析，这表明需要有3719例患者，以达到所需的信息的大小确定。 NSBB并未减少HCC相关死亡率（RD-0.011;95％CI-0.040到0.017）。
结论

NSBB可以预防肝癌肝硬化患者...

这篇文章是受版权保护的。版权所有。

疯一点好

看不太明白，到底用药后的肝癌发生率与不用药的差异有多大？

StephenW

回复 疯一点好 的帖子

摘要说，“也许(maybe)”.结果需要统计学了解.