TDF与ETV对CHB患者HCC发生率的有效性：Meta分析

StephenW

The effectiveness of TDF versus ETV on incidence of HCC in CHB patients: a meta analysis

    Zeyu Zhang, Yufan Zhou, Jiajin Yang, Kuan Hu and Yun HuangEmail authorView ORCID ID profile

BMC Cancer201919:511

https://doi.org/10.1186/s12885-019-5735-9

©  The Author(s). 2019

    Received: 2 November 2018Accepted: 21 May 2019Published: 29 May 2019

Open Peer Review reports
Abstract
Background

It has been proved that nucleos(t) ide analogues (NAs) therapy could improve underlying liver disease and reduce the incidence of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). However, the difference of effectiveness in reducing HCC occurrence between tenofovir (TDF) and enticavir (ETV), two first-line NAs drugs, is still little known. This meta analysis aims to assess the efficacy in reducing incidence of HCC comparing tenofovir monotherapy with entecavir monotherapy among chronic hepatitis B (CHB) patients by analyzing their long-term clinical outcomes.
Methods

Databases including PubMed, Embase, Cochrane Central Register of Controlled Trial, and ISI Web of Science were fully investigated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. For the included articles, two of the authors independently extracted and confirmed relevant data. Review Manager software (RevMan 5.3) was using for meta analysis.
Results

Seven articles with 3698 patients were finally included in this research, 1574 in tenofovir group and 2124 in entecavir group. For meta analysis, the incidence of HCC was significantly lower among the tenofovir group than entecavir group [rate ratio (95% CI) of 0.66 (0.49, 0.89), P = 0.008], while there was no statistical significance in incidence of death or transplantation [rate ratio (95% CI) of 0.78 (0.55, 1.13), P = 0.19], encephalopathy [risk ratio (95% CI) of 0.72 (0.45, 1.13), P = 0.15] or variceal bleeding [risk ratio (95% CI) of 0.71 (0.34, 1.50), P = 0.37] between the two groups.
Conclusion

There is a better effect of tenofovir in reducing HCC incidence than entecavir, which indicates tenofovir should be used more widely while treating chronic hepatitis B patients. However before applying, randomized controlled trial and large prospective cohort study should be performed in the future.
Keywords

    Entecavir
    Tenofovir
    Chronic hepatitis B
    Hepatocellular carcinoma
    Meta-analysis

StephenW

TDF与ETV对CHB患者HCC发生率的有效性：Meta分析

    张泽宇，周玉凡，杨家进，胡宽和黄云电子邮件authorView ORCID ID profile

BMC Cancer201919：511

https://doi.org/10.1186/s12885-019-5735-9

©The Author（s）。 2019

    收稿日期：2018年11月2日接受日期：2019年5月21日出版日期：2019年5月29日

打开同行评审报告
抽象
背景

已经证明，核苷（酸）类似物（NAs）治疗可以改善潜在的肝脏疾病并降低乙型肝炎病毒（HBV）相关的肝细胞癌（HCC）的发病率。然而，降低替诺福韦（TDF）和恩替卡韦（ETV）（两种一线NAs药物）之间HCC发生的有效性差异仍然鲜为人知。该meta分析旨在通过分析慢性乙型肝炎（CHB）患者的长期临床结果，评估降低替诺福韦单药治疗与慢性乙型肝炎（CHB）患者恩替卡韦单药治疗相比降低HCC发生率的效果。
方法

根据系统评价和元分析的首选报告项目（PRISMA）指南，对PubMed，Embase，Cochrane中心对照试验和ISI Web of Science等数据库进行了全面调查。对于所包含的文章，两位作者独立提取并确认了相关数据。 Review Manager软件（RevMan 5.3）用于元分析。
结果

本研究共纳入7篇3698例患者，替诺福韦组1574例，恩替卡韦组2124例。对于荟萃分析，替诺福韦组的HCC发生率显着低于恩替卡韦组[比率（95％CI）为0.66（0.49,0.89），P = 0.008]，而死亡发生率无统计学意义或移植[比率（95％CI）为0.78（0.55,1.13），P = 0.19]，脑病[风险比（95％CI）为0.72（0.45,1.13），P = 0.15]或静脉曲张出血[风险比（两组之间的95％CI）为0.71（0.34,1.50），P = 0.37]。
结论

替诺福韦在降低HCC发病率方面比恩替卡韦有更好的效果，这表明替诺福韦在治疗慢性乙型肝炎患者时应该更广泛地使用。然而，在应用之前，应该在将来进行随机对照试验和大型前瞻性队列研究。
关键词

    恩替卡韦
    替诺福韦
    慢性乙型肝炎
    肝细胞癌
    Meta分析

StephenW

https://bmccancer.biomedcentral. ... 6/s12885-019-5735-9

天上飞鱼

替诺能比恩替更有效的降低肝癌风险。证据越来越多了。虽然现在恩替价格低、副作用少，但权衡利弊，还是用替诺比较好。

享自由

没啥意义，想当初大批专家还鼓吹替比夫定能保护肾脏呢！核苷和核苷酸原理就是抑制病毒复制，和降低癌症有啥关系。那些所谓的数据，其他因素太多了，10和6真证明不了什么