Interferon and prevention of hepatocellular carcinoma in viral cirrhosis:: an evidence-based approach
Interferon and prevention of hepatocellular carcinoma in viral cirrhosis:: an evidence-based approach
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DOI：
10.1016/s0168-8278(01)00005-8
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发表时间：
2001-04-01
影响因子：
25.7
通讯作者：
Craxì, A
中科院分区：
文献类型：
--
作者：
Cammà, C;Giunta, M;Craxì, A
背景/目的：通过对现有文献的荟萃分析，评估干扰素（IFN）是否能降低乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）相关儿童A型肝硬化患者的肝细胞癌（HCC）发生率。方法：选择3项随机对照试验和15项非随机对照试验，共4614例患者，并将IFN与未治疗进行比较。从每项研究中提取IFN治疗和未治疗患者的HCC发生率数据。采用DerSimonian和Laird风险差异（RD）方法进行meta分析。结果：观察到HCV（总RD -12.8%; 95% CI -8.3至-17.2%,P < 0.0001）和HBV（总RD -6.4%; 95% CI - 2.8至-10%，P < 0.001）在治疗和未治疗的肝硬化患者中HCC发生率不同。在hcv相关肝硬化中，持续对IFN有反应的患者的HCC发展率低于未治疗的患者（总RD -19.1%; 95% CI - 13.1至相似的25.2,P < 0.00001）。试验之间的异质性较低（P = 0.053），无反应患者与未治疗患者的异质性也较低（总RD -11.8%; 95% CI -6.4至-19.1%,P < 0.0001），尽管存在显著的异质性。研究之间的不一致性是主要问题，无论是HCV (chi (2) = 58.16, 13 DF；P < 0.0001)和HBV ((2) = 26.4, 6 DF；P = 0.0001)相关的肝硬化，随访时间短于60个月时也是如此。只有在评估欧洲报告的数据时才观察到一致的结果：在该亚组中，HCC对HBV没有预防作用（总RD - 4.8%; 95% CI - 11.1-1.5%， P不显著），对HCV只有微弱的作用（总RD -10%； 95% CI -5.9至-14.2%;P < 0.0001）。结论：文献资料汇总提示IFN对丙型肝炎相关肝硬化患者的HCC发展有轻微的预防作用。这种影响的程度很低，观察到的好处可能是由于虚假的关联。在IFN的持续应答者中，预防效果更为明显。干扰素似乎不影响hbv相关肝硬化中HCC的发生率。(C) 2001年欧洲肝脏研究协会。Elsevier Science B.V.版权所有。
Background/Aims: To evaluate by meta-analysis of available literature whether interferon (IFN) reduces the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C virus (HCV)-related Child A cirrhosis.Methods: Three randomized controlled trials and 15 nonrandomized controlled trials, including 4614 patients and comparing IFN to no treatment, were selected. Data on the incidence of HCC in IFN treated and untreated patients were extracted from each study. Meta-analysis by the DerSimonian and Laird risk difference (RD) method was used to pool observations.Results: A different incidence of HCC between treated and untreated cirrhotic patients was observed for HCV (overall RD -12.8%; 95% CI -8.3 to -17.2%, P < 0.0001) and HBV (overall RD -6.4%; 95% CI - 2.8 to -10%, P < 0.001). In HCV-related cirrhosis, the rate of HCC development was lower in sustained responders to IFN than in untreated patients (overall RD -19.1%; 95% CI - 13.1 to similar to 25.2, P < 0.00001). With low heterogeneity among trials (P = 0.053), and also in nonresponders vs, untreated patients (overall RD -11.8%; 95% CI -6.4 to -19.1%, P < 0.0001), although with significant heterogeneity. Inconsistency among the studies was a major problem, both for HCV (chi (2) = 58.16 with 13 DF; P < 0.0001) and HBV ((2) = 26.4 with 6 DF; P = 0.0001) related cirrhosis, and also when follow-up was shorter than 60 months. Consistent results were only observed when assessing data from European reports: in this subgroup no preventive effect of HCC was shown for HBV (overall RD - 4.8%; 95% CI - 11.1-1.5%, P, not significant), and only a weak effect for HCV (overall RD -10%; 95% CI -5.9 to -14.2%; P < 0.0001).Conclusions: Literature data pooling suggests a slight preventive effect of IFN on HCC development in patients with HCV-related cirrhosis. The magnitude of this effect is low and the observed benefit might be due to spurious associations. The preventive effect is more evident among sustained responders to IFN. IFN does not seem to affect the rate of HCC in HBV-related cirrhosis. (C) 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.