TY - JOUR
T1 - Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy
T2 - a systematic review, meta-analyses, and meta-regression
AU - Waziry, Reem
AU - Hajarizadeh, Behzad
AU - Grebely, Jason
AU - Amin, Janaki
AU - Law, Matthew
AU - Danta, Mark
AU - George, Jacob
AU - Dore, Gregrory J.
PY - 2017/12
Y1 - 2017/12
N2 - Background & Aims: The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. The aims of this study were to compare the rate of HCC occurrence in patients with HCV-related cirrhosis, following DAA vs. interferon (IFN)-based cure, and to compare the rate of HCC recurrence in patients who received curative HCC treatment, following DAA vs. IFN-based cure. Methods: A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random-effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person-years (py) among patients with a sustained virological response (SVR). Results: A total of 41 studies (n = 13,875 patients), including 26 on HCC occurrence (IFN = 17, DAA = 9; prospective = 19, retrospective = 5, retrospective-prospective = 2), and 17 on HCC recurrence (IFN = 7, DAA = 10; prospective = 11, retrospective = 5 and retrospective-prospective = 1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 vs. 5.5. years), and average age older (60 vs. 52. years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 vs. 5.0. years), but average age similar (64 vs. 66. years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86-1.52) and 2.96/100 py (95% CI 1.76-4.96) in IFN and DAA studies respectively. HCC recurrence was 9.21/100 py (95% CI 7.18-11.81) and 12.16/100 py (95% CI 5.00-29.58) in IFN and DAA studies respectively. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68; 95% CI 0.18-2.55; p = 0.55) or recurrence (RR 0.62, 95% CI 0.11-3.45, p = 0.56). Conclusion: There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy. Lay summary: The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. We conducted a meta-analysis to compare occurrence and recurrence of HCC in patients receiving either DAA or interferon (IFN) therapy. There is no evidence that HCC occurrence or recurrence is different between patients receiving DAA or IFN therapy. © 2017 European Association for the Study of the Liver.
AB - Background & Aims: The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. The aims of this study were to compare the rate of HCC occurrence in patients with HCV-related cirrhosis, following DAA vs. interferon (IFN)-based cure, and to compare the rate of HCC recurrence in patients who received curative HCC treatment, following DAA vs. IFN-based cure. Methods: A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random-effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person-years (py) among patients with a sustained virological response (SVR). Results: A total of 41 studies (n = 13,875 patients), including 26 on HCC occurrence (IFN = 17, DAA = 9; prospective = 19, retrospective = 5, retrospective-prospective = 2), and 17 on HCC recurrence (IFN = 7, DAA = 10; prospective = 11, retrospective = 5 and retrospective-prospective = 1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 vs. 5.5. years), and average age older (60 vs. 52. years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 vs. 5.0. years), but average age similar (64 vs. 66. years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86-1.52) and 2.96/100 py (95% CI 1.76-4.96) in IFN and DAA studies respectively. HCC recurrence was 9.21/100 py (95% CI 7.18-11.81) and 12.16/100 py (95% CI 5.00-29.58) in IFN and DAA studies respectively. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68; 95% CI 0.18-2.55; p = 0.55) or recurrence (RR 0.62, 95% CI 0.11-3.45, p = 0.56). Conclusion: There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy. Lay summary: The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. We conducted a meta-analysis to compare occurrence and recurrence of HCC in patients receiving either DAA or interferon (IFN) therapy. There is no evidence that HCC occurrence or recurrence is different between patients receiving DAA or IFN therapy. © 2017 European Association for the Study of the Liver.
KW - hepatocellular carcinoma
KW - occurrence
KW - recurrence
KW - epidemiology
KW - chronic hepatitis C virus
KW - Recurrence
KW - Chronic hepatitis C virus
KW - Hepatocellular carcinoma
KW - Epidemiology
KW - Occurrence
UR - http://www.scopus.com/inward/record.url?scp=85029561799&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2017.07.025
DO - 10.1016/j.jhep.2017.07.025
M3 - Article
C2 - 28802876
SN - 0168-8278
VL - 67
SP - 1204
EP - 1212
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 6
ER -