Singal AK, Singh A, Jaganmohan S, Guturu P, Mummadi R, Kuo YF, Sood GK
Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis. [JOURNAL ARTICLE]
Clin Gastroenterol Hepatol 2009 Oct 29.
BACKGROUND & AIMS:: The effects of antiviral therapy on prevention of hepatocellular carcinoma (HCC) in patients with HCV-related cirrhosis are unclear. We performed a systematic review and meta-analysis to assess HCC risk reduction in patients with HCV-related cirrhosis who have received antiviral therapy.
METHODS:: Twenty studies (4700 patients) were analyzed that compared untreated patients with those given IFN alone (regular or PEG-IFN) or ribavirin. Risk ratios [RR] determined effect size using the random effects model of DerSimonian and Laird.
RESULTS:: Pooled data showed reduced HCC risk in the treatment group (RR=0.43, 95% confidence interval [CI] 0.33-0.56; P<0.00001], although the data were heterogenous (chi2=59.10, p<0.00001). Meta-regression analysis showed that studies with follow-up durations of more than 5 years contributed to heterogeneity (p=0.03). Analysis of 14 studies (n=3310) reporting sustained virologic response (SVR) rates with antiviral treatment showed reduced HCC risk in patients with a SVR, compared with non-responders (0.35, 0.26-0.46; P<0.00001); the maximum benefits were observed in patients treated with ribavirin-based regimens (RR=0.25, CI 0.14-0.46, P<0.00001). Meta-analysis of 4 studies assessing the role of maintenance IFN in non-responders did not show HCC risk reduction (RR=0.58, CI 0.33-1.03; P=0.06). There was no heterogeneity among studies comparing patients with SVRs to non-responders (chi2=8.67, P=0.8) or studies comparing maintenance IFN (chi2=3.82, P=0.28). No publication bias was detected by Egger's test analysis (p > 0.1).
CONCLUSIONS:: The risk of HCC is reduced among patients with HCV who achieve an SVR with antiviral therapy. Maintenance therapy with IFN does not reduce HCC risk among patients that do not respond to initial therapy.
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