摘要
Aim:Hepatitis C virus(HCV)is the leading cause of hepatocellular carcinoma(HCC)in the United States.Achieving sustained viral response with interferon(IFN)treatment reduces the risk from 3%-5%to 0.5%-1%annually.Several studies reported unexpectedly high rates of HCC after treatment with direct-acting antivirals(DAAs).The aim of our study was to compare HCC rates in DAA-,IFN-treated and untreated populations.Methods:A literature search was conducted using ScienceDirect,Ovid?,Web of Science and MEDLINE through January 2019.Studies were included if they measured rates of de novo or recurrent HCC(following curative treatment)in HCV-infected persons.We included 138 studies(n=177,512).Simple pooling of data and meta-analysis were performed,using the random effects method.Results:Mean age was higher in the DAA-treated vs.IFN-treated group(58.4 years vs.52.6 years;P=0.0073),as were diabetes prevalence(34.5%vs.11.7%;P≤0.001)and incident cirrhosis(47.8%vs.34.2%,P=0.0017).The incidence rate of de novo HCC was 2.01/100 person-years(py)(95%CI:1.38,2.67)in the DAA group and 1.45/100py(95%CI:0.98,1.94)in the IFN-treated group.HCC recurred at 16.76/100py(95%CI:10.75,22.91)in the DAA-treated group vs.20.04/100py(95%CI:2.58,45.21)after IFN.After adjusting for factors such as age and cirrhosis,the hazard ratio was 0.58(95%CI:0.20,1.07)for HCC occurrence and 0.59(95%CI:0.24,1.03)for HCC recurrence after DAA treatment compared to IFN-based treatment. ;Conclusion:We did not find evidence for increased rates of HCC in DAA-treated compared with IFN-treated patients.Compared to those treated with IFN,older patients with additional risk factors for HCC were treated with DAAs.This imbalance appears to explain the higher numerical incidence of HCC among DAA-treated patients.
基金
Raymond T.Chung received grant support(NIH grant DK078772)
