Meta-Analysis:
Development of hepatocellular carcinoma in patients who have obtained a sustained virologic response SVR versus no SVR after antiviral therapy for hepatitis C: a systematic review and metaanalysis
Ali Hosni1, Tawnya Hansen2, John Sampalis3, Yuxin Tu4 and Arlene Nugent5
1Princess Margaret Cancer Centre, Toronto, Ontario, Canada
2Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
3University of Montreal, Montreal, Québec, Canada
4Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Correspondence to:
Arlene Nugent, email: [email protected]
Keywords: hepatocellular carcinoma; hepatitis C; antiviral therapy; sustained virologic response; cirrhosis
Received: June 06, 2018 Accepted: July 28, 2018 Published:
ABSTRACT
Purpose: Hepatitis C virus (HCV) patients can achieve a sustained virologic response (SVR) following antiviral therapy. This meta-analysis aimed to determine the impact of SVR on development of HCC.
Materials and Methods: A literature search (1989–2015) was performed for analysis of studies with HCV patients receiving anti-viral therapy in which HCC incidence was recorded in SVR and non-SVR groups. Study quality risk of bias was assessed using the Newcastle-Ottawa Scale. Statistical analysis included determination of the risk ratio (RR) through a random effects model on the incidence of HCC. Meta-regression analysis assessed the potential impact of cirrhosis on the RR.
Results: Overall 1095 articles were reviewed, of whom 37 studies were eligible for this analysis. Total sample size: 22,858 patients; median age range: 40–63 yr; median follow-up range: 2–13 year; fibrosis/cirrhosis stage: non-cirrhotic (F0-2 stage) range: 0–86% and cirrhotic (F3-4 stage) range: 2–100%; antiviral therapy: interferon-based in 36 studies and direct acting antiviral drugs (DAAD) in 1 study; overall SVR vs. non-SVR rate: 48% vs. 52%; HCC incidence in SVR vs. non-SVR groups: 3.2% vs. 12.4%. The pooled RR of HCC incidence was 0.214 (95% CI, 0.168–0.273; p = 0.001) in favour of SVR with 78.6% reduction in the risk of developing HCC in SVR patients. Cirrhosis (F3-4) was significantly associated with the RR (adjusted RR: 0.245, p < 0.0001) and the reduction in the risk of HCC development changed to 75.5% in SVR cirrhotic patients.
Conclusions: Obtaining SVR in HCV patients decreases the risk of developing HCC, especially if treatment received at earlier non-cirrhotic stage.