乙型肝炎表面抗原血清清除的持久性和隨後發生肝細胞癌的

StephenW

Durability of Hepatitis B Surface Antigen seroclearance and subsequent Risk for hepatocellular Carcinoma : a meta-analysis
Aixin Song  1 , Wang Xiaoxiao  1 , Junfeng Lu  1 , Yi Jin  1 , Lina Ma  1 , Zhongjie Hu  1 , Yanhong Zheng  1 , Chengli Shen  2 , Xinyue Chen  1
Affiliations
Affiliations

    1
    First Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.
    2
    Division of Surgical Oncology, James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio.

    PMID: 33455067 DOI: 10.1111/jvh.13471

Abstract

Hepatitis B surface antigen (HBsAg) seroclearance is regarded as the ideal endpoint for antiviral treatment. However, reports on the durability of and outcomes after HBsAg seroclearance are few, which has become a focus in clinical practice. This meta-analysis was performed to evaluate the durability and hepatocellular carcinoma (HCC) incidence after HBsAg seroclearance after treatment cessation. We searched PubMed, EMBASE, Medline and Web of Science for studies that reported the durability and HCC incidence after HBsAg seroclearance published between 1 January 2000 and 31 January 2020. Data were analyzed by a random-effects model. Thirty-eight studies and 43924 patients were finally included. The results showed that HBsAg seroclearance was durable, with a pooled recurrence rate of 6.19% (95% CI: 4.10-8.68%). There was no significant difference in recurrence rates after different seroclearance methods or among recurrence types and different regions. Anti-HBs seroconversion resulted in a significantly reduced recurrence rate (RR=0.25, P <0.001). Patients who experienced HBsAg seroclearance had significantly lower HCC incidence than HBsAg-positive (RR=0.41, P <0.001). The pooled HCC incidence after HBsAg seroclearance was 1.88%, this rate was reduced to 0.76% among patients without baseline cirrhosis. In conclusion, the analysis during an average follow-up of 4.74 years suggested that in patients who experienced sustained HBsAg seroclearance and anti-HBs seroconversion, this was associated with low HCC incidence. Patients without baseline cirrhosis benefited even more. We emphasize the importance of gaining HBsAg seroclearance while highlighting the benefits of achieving this as early as possible.

Keywords: HBV; HBsAg; HCC; meta-analysis; recurrence rate.

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StephenW

乙型肝炎表面抗原血清清除的持久性和随后发生肝细胞癌的风险：一项荟萃分析
宋爱新1，王晓晓1，陆俊峰1，易进1，马丽娜1，胡忠杰1，郑彦宏1，沉成立2，陈新月1
隶属关系
隶属关系

    1个
    首都医科大学附属北京佑安医院肝病中心第一科，北京
    2
    俄亥俄州哥伦布市俄亥俄州立大学韦克斯纳医学中心詹姆斯癌症医院外科肿瘤科。

    PMID：33455067 DOI：10.1111 / jvh.13471

抽象

乙肝表面抗原（HBsAg）血清清除被认为是抗病毒治疗的理想终点。但是，关于HBsAg血清清除的持久性和转归的报道很少，这已成为临床实践的重点。进行这项荟萃分析，以评估治疗终止后HBsAg血清清除后的持久性和肝细胞癌（HCC）发生率。我们对PubMed，EMBASE，Medline和Web of Science进行了搜索，以研究报告在2000年1月1日至2020年1月31日之间发布的HBsAg血清清除后的持久性和HCC发生率的研究。通过随机效应模型分析数据。最后纳入了38项研究和43924例患者。结果显示，HBsAg血清清除具有持久性，合并复发率为6.19％（95％CI：4.10-8.68％）。不同的血清清除方法或不同的复发类型和不同区域的复发率无显着差异。抗HBs血清转换可显着降低复发率（RR = 0.25，P <0.001）。经历过HBsAg血清清除的患者的HCC发生率明显低于HBsAg阳性（RR = 0.41，P <0.001）。 HBsAg血清清除后合并的HCC发生率为1.88％，在没有基线肝硬化的患者中，这一比率降低到0.76％。总之，平均随访时间为4.74年的分析表明，在经历持续HBsAg血清清除和抗HBs血清转化的患者中，这与低HCC发生率相关。没有基线肝硬化的患者受益更大。我们强调获得HBsAg血清清除的重要性，同时强调尽早实现这一目标的好处。

关键字：HBV；乙肝表面抗原HCC；荟萃分析复发率。

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