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肝胆相照论坛 论坛 学术讨论& HBV English AASLD2020[1055]替诺福韦VS ETV肝细胞癌的发病率 ...
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AASLD2020[1055]替诺福韦VS ETV肝细胞癌的发病率 [复制链接]

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发表于 2020-11-3 21:12 |只看该作者 |倒序浏览 |打印
1055
HEPATOCELLULAR CARCINOMA INCIDENCE WITH TENOFOVIR
VS ENTECAVIR IN CHRONIC HEPATITIS B: A SYSTEMATIC
REVIEW AND META-ANALYSIS
Cheng-Hao Tseng1,2, Yao-Chun Hsu3, Tzu-Haw Chen4, Fanpu
Ji Jr.5, I-Sung Chen4, Ying-Nan Tsai6, Hoang Hai7, Thuy
Thi Thanh Le8, Tetsuya Hosaka9, Hitomi Sezaki9, John A.
Borghi10, Ramsey Cheung11, Masaru Enomoto7,8 and Mindie
H. Nguyen11,12, (1)E-DA Cancer Hospital, (2)Gastroenterology
and Hepatology, E-DA Cancer Hospital, Kaohsiung, Taiwan, (3)
Center of Liver Diseases, E-Da Hospital, (4)Gastroenterology
and Hepatology, E-DA Hospital, (5)Infectious Diseases, The
Second Affiliated Hospital of Xi’an Jiaotong University, (6)
Gastroenterology and Hepatology, E-DA Cancer Hospital,
(7)Hepatology, Osaka City University Graduate School
of Medicine, (8)Department of Hepatology, Osaka City
University Graduate School of Medicine, (9)Hepatology,
Toranomon Hospital, (10)Lane Medical Library & Knowledge
Management Center, Stanford University, (11)Division of
Gastroenterology and Hepatology, Department of Medicine,
Stanford University Medical Center, (12)Gastroenterology
and Hepatology, Stanford University Medical Center
Background: Whether TDF and ETV differ in their association
with HCC risk in CHB patients remains controversial We
identified eight existing meta-analyses with inconsistent
conclusions, which was likely due to heterogeneity that
were not fully addressed and study limitations that were
overlooked This meta-analysis aims to analyze the updated
data and elucidate where the heterogeneity originate from
Methods: We searched PubMed, Embase, Web of Science,
and the Cochrane library for relevant studies published
between January 1, 2006 and April 17, 2020 and abstracts
from major international conferences in 2018 and 2019
The hazard ratio (HR) for incident HCC was pooled using a
random-effects model Results: A total of 31 studies involving
119,053 patients were analyzed: The 5-year cumulative HCC
incidence with ETV and TDF were respectively 5 97% (95%
CI, 5 81-6 13%) versus 3 06% (95% CI, 2 86-3 26%) from
28 unmatched studies, and 3 44% (95% CI, 3 08-3 80%)
versus 3 39% (95% CI, 2 94-3 83%) from 8 matched studies,
indicating preexisting confounders between the ETV and TDF
groups in unmatched studies Analysis of 14 comparative
studies with covariate adjustment found that TDF and ETV
were not significantly associated with different HCC risks
(adjusted HR, 0 88; 95% CI, 0 73-1 07; P=0 20), though
heterogeneity was significant (I2=56 4%, P=0 004) (Figure
1). Subgroup analysis identified the source of heterogeneity
among the different study settings and confirmed that there
was no difference between TDF and ETV among hospitalbased
clinical cohort studies (adjusted HR of 1 03, 95% CI,
0 88-1 21; I2=0%), while TDF was found to be superior in
administrative database research (adjusted HR, 0 67, 95%
CI, 0 59-0 76; I2=0%).There was also no significant difference
ETV and TDF from studies with no or minimal disparity in
follow-up duration (adjusted HR, 0·88; 95% CI, 0·70-1·11;
I2=51·1%), while TDF was associated with lower HCC risk as
compared to ETV (adjusted HR, 0·69; 95% CI, 0·61-0·79; I2=0
%) among studies where the follow-up duration for ETV was
one year or longer Conclusion: Comprehensive analysis
found no significant difference between TDF and ETV with
incident HCC The superiority of TDF in administrative
database research is likely due to incomplete adjustment
for confounders as relevant clinical and laboratory data are
generally not available in these databases Thus, the choice
of which agent should depend on patient factors such as cost
and tolerability.

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发表于 2020-11-3 21:13 |只看该作者
1055
替诺福韦肝细胞癌的发病率
VS ETV:系统性
回顾与元分析
曾成豪1,2,徐耀春3,陈子豪4,番埔
Ji Jr.5,陈宜松4,蔡英楠6,黄海7,翠
Thi Thanh Le8,Tetsuya Hosaka9,Hitomi Sezaki9,John A.
Borghi10,Ramsey Cheung11,Masaru Enomoto7,8和Mindie
H.Nguyen11,12,(1)E-DA癌症医院,(2)胃肠病学
台湾高雄E-DA癌症医院肝癌和肝病(3)
E-Da医院肝病中心,(4)胃肠病学
E-DA医院,肝病和肝病,(5)
西安交通大学附属第二医院,(6)
E-DA癌症医院消化内科和肝病科
(7)大阪市立大学大学院肝病学
大阪市内科(8)
大学医学研究科,(9)肝病,
虎之门医院(10)莱恩医学图书馆与知识
斯坦福大学管理中心,(11)
医学部胃肠病学和肝病学
斯坦福大学医学中心,(12)肠胃病学
和斯坦福大学医学中心
背景:TDF和ETV在关联方面是否有所不同
CHB患者的HCC风险仍存在争议
确定了八个不一致的现有荟萃分析
结论,可能是由于异质性
没有得到充分解决,研究局限性
被忽略的荟萃分析旨在分析更新的
数据并阐明异质性源自何处
方法:我们搜索了PubMed,Embase,Web of Science,
和Cochrane图书馆发布了相关研究
2006年1月1日至2020年4月17日之间的摘要
来自2018年和2019年的主要国际会议
事故HCC的危险比(HR)使用
结果:共有31项研究,涉及
分析了119,053例患者:5年累计HCC
ETV和TDF的发生率分别为5 97%(95%
CI,5 81-6 13%),而3 6%(95%CI,2 86-3 26%)
28个无与伦比的研究和3个44%(95%CI,3个08-3 80%)
对比8项匹配研究中的3 39%(95%CI,2 94-3 83%),
表明ETV和TDF之间已经存在混杂因素
无与伦比的研究中的不同群体14项比较的分析
协变量调整的研究发现,TDF和ETV
与不同的HCC风险没有显着相关
(调整后的HR,0 88; 95%CI,0 73-1 07; P = 0 20)
异质性显着(I2 = 56 4%,P = 0 004)(图
1)。亚组分析确定了异质性的来源
在不同的研究环境中并确认
医院之间的TDF和ETV之间没有差异
临床队列研究(调整后的HR为1 03、95%CI,
0 88-1 21; I2 = 0%),而TDF在
行政数据库研究(调整后的HR,0 67,95%
CI,0 59-0 76; I2 = 0%)。也没有显着差异
ETV和TDF来自无差异或差异极小的研究
随访时间(调整后的HR,0·88; 95%CI,0·70-1·11;
I2 = 51·1%),而TDF与较低的HCC风险相关,因为
与ETV相比(调整后的HR,0·69; 95%CI,0·61-0·79; I2 = 0
在ETV的随访时间为
一年或更长时间结论:综合分析
发现TDF和ETV之间没有显着差异
HCC事件TDF在行政管理方面的优势
数据库研究可能是由于调整不完全
对于混杂因素,因为相关的临床和实验室数据是
这些数据库通常不可用,因此,选择
哪种药物应取决于患者因素,例如费用
和容忍度。
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