抗病毒治疗降低了丙肝病毒性肝硬化患者发生肝癌的风险

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抗病毒治疗降低了丙肝病毒性肝硬化患者发生肝癌的风险
Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus–related cirrhosis.
出处：Clin Gastroenterol Hepatol   2010    8(2) :192-199
作者：Singal AK, Singh A, Jaganmohan S, Guturu P, Mummadi R, Kuo YF, Sood GK.
PMID：19879972

丙肝病毒性肝硬化患者中，那些干扰素治疗有效的患者发展为肝细胞癌的风险要小于干扰素治疗无应答者。干扰素治疗降低丙肝感染患者肝细胞癌发生风险的疗效目前存在争议。为分析这个问题，研究者做了一个包含32个研究的meta分析来评价干扰素治疗的有效性。每个研究主要结果为终末随访时发生肝细胞癌。有20个研究比较了用干扰素（联合或不联合病毒唑）丙肝病毒性肝硬化患者与不采用干扰素治疗患者肝细胞癌的发生风险，分析表明治疗患者的肝细胞癌的发生率较不治疗者低(相对危险RR, 0.43; 95% 置信区间CI, 0.33–0.56)，但数据有异质性；荟萃分析表明随访超过5年的研究与异质性有关。在有关干扰素治疗的14个研究中，那些对抗病毒治疗有应答者较无应答者肝细胞癌的发生率低(RR, 0.35; 95% CI, 0.26–0.46)。对5个研究的分析表明采用干扰素联合病毒唑治疗的患者，有应答者较无应答者肝细胞癌的发生率低(RR, 0.25; 95% CI, 0.14–0.46)。有4个研究分析了初次治疗而无应答患者中维持干扰素治疗，患者的肝细胞癌的发生风险并未降低。未确定发表偏倚。

Among cirrhotic HCV patients, those who achieved sustained virologic response from interferon therapy had lower risk for developing HCC than nonresponders.
The efficacy of interferon (IFN) for reducing risk for hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) infection is controversial. To address this issue, investigators conducted a meta-analysis of 32 studies that evaluated the use of IFN in this setting. The primary outcome in each study was occurrence of HCC at the last follow-up evaluation.
In 20 studies that compared cirrhotic HCV patients treated with IFN (with or without ribavirin) versus untreated patients, pooled data showed that treated patients had lower risk for HCC (risk ratio, 0.43; 95% confidence interval, 0.33–0.56). However, the data were heterogeneous; metaregression analysis revealed that studies with follow-up duration of >5 years contributed to the heterogeneity.
In 14 studies that reported HCC development based on sustained virologic response (SVR) to IFN therapy, patients who achieved SVR had significantly lower risk for HCC than nonresponders (RR, 0.35; 95% CI, 0.26–0.46). Analysis of five studies showed that among patients who received IFN plus ribavirin, those who achieved SVR had the lowest risk for HCC development versus nonresponders (RR, 0.25; 95% CI, 0.14–0.46).
In four studies that analyzed the effect of maintenance IFN in nonresponders to initial therapy, patients who received maintenance IFN achieved no benefit in terms of HCC risk reduction. No publication bias was identified.

专家评价：
Comment: This excellent systematic review and meta-analysis suggests that cirrhotic HCV patients who achieve SVR from IFN therapy are at lower risk for developing HCC than nonresponders. The evidence is less convincing that receiving treatment of any kind for reducing HCC risk is better than receiving no treatment at all. Also, maintenance therapy with IFN in nonresponders does not offer any benefit for HCC risk reduction. This study provides additional rationale for treating HCV cirrhotic patients with IFN-based therapy.
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology April 2, 2010



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