Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis
Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis
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DOI：
10.1136/gutjnl-2020-323663
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发表时间：
2021-03-19
期刊：
影响因子：
24.5
通讯作者：
Reig, Maria
中科院分区：
文献类型：
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作者：
Sapena, Victor;Enea, Marco;Reig, Maria
目的肝细胞癌（HCC）治疗成功后，直接作用抗病毒药物（DAA）的疗效仍存在争议。个体患者数据的荟萃分析评估HCC复发的风险后DAA administration.Design我们汇总了977例连续患者的数据，从21项研究HCV相关肝硬化和HCC，手术/局部区域治疗后达到完全放射学反应，并收到DAA（DAA组）。复发或死亡风险表示为HCC复发或死亡/100人年（100 PY）。来自ITA. LI. CA的倾向评分匹配患者。队列（n=328）作为未暴露于DAA的对照（无DAA组）。结果DAA治疗患者每100 PY的复发率和死亡风险分别为20（95% CI 13.9 ~ 29.8，I-2=74.6%）和5.7（2.5 ~ 15.3，I-2=54.3）。复发的预测因素是甲胎蛋白对数（相对危险度（RR）=1.11，95%CI 1.03 - 1.19; p=0.01，每1 log ng/mL），DAA开始前HCC复发史（RR=1.11，95%CI 1.07 - 1.16; p
Objective The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration.Design We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson.Results Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I-2=74.6%) and 5.7 (2.5 to 15.3, I-2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p