直接抗病毒药物对HCV相关肝细胞癌根治性治疗后复发影响的Meta分析

Effect of direct-acting antiviral on the recurrence hepatitis C virus-related hepatocellular carcinoma after curative treatment:A Meta-analysis

目的评价直接抗病毒药物(DAA)对HCV相关肝细胞癌(HCC)根治性治疗后复发的影响。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网、中国生物医学数据库、万方数据库、维普数据库中有关DAA与HCV相关HCC复发的临床研究,检索时间为自数据库创立至2020年4月。采用Stata 14.0软件进行Meta分析。各研究间异质性采用Cochran Q检验,非异质性数据采用固定效应模型,异质性数据采用随机效应模型。采用Egger回归法或Begg秩相关法检验是否存在发表偏倚。结果共纳入10篇文献,11项研究。其中有8篇文献,9项研究比较了DAA与未行抗HCV治疗对根治性治疗后HCC复发的影响。DAA组共纳入991例患者,未治疗组共纳入808例患者,Meta分析结果显示,DAA类药物可降低根治性治疗后HCV感染者HCC的复发率(HR=0.42,95%CI:0.28~0.36,P<0.001)。有3篇文献比较了DAA与干扰素治疗丙型肝炎对于根治性治疗后HCC复发的影响,其中DAA组共纳入267例患者,干扰素组共纳入212例患者。Meta分析结果显示,DAA与干扰素类药物对于HCV相关HCC复发率的影响差异没有统计学意义(HR=0.85,95%CI:0.64~1.15,P=0.298)。结论干扰素与DAA均可降低根治性治疗后HCV相关HCC的复发率,且二者之间不存在统计学差异。

Objective To investigate the effect of direct-acting antiviral(DAA)on the recurrence of hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)after curative treatment.Methods PubMed,Web of Science,Cochrane Library,CNKI,CBM,Wanfang Data,and VIP were searched for the clinical studies of DAA and the recurrence of HCV-related HCC published up to April 2020.Stata 14.0 software was used to perform the meta-analysis.The Cochran Q test was used to evaluate heterogeneity between studies;the fixed effects model was used for non-heterogeneous data,and the random effects model was used for heterogeneous data.The Egger regression method or the Begg rank correlation method was used to evaluate the presence or absence of publication bias.Results A total of 10 articles(11 studies)were included in our study,among which 8 articles(9 studies)compared the effect of DAA versus the absence of anti-HCV therapy on the recurrence of HCC after curative treatment.There were 991 patients in DAA group and 808 patients in untreated group.The results of the meta-analysis showed that DAA reduced the recurrence rate of HCC after curative treatment in patients with HCV infection(hazard ratio[HR]=0.42,95%confidence interval[CI]:0.28?0.36,P<0.001).Three articles compared the effect of DAA versus interferon for the treatment of hepatitis C on the recurrence of HCC after curative treatment,with 267 patients in DAA group and 212 in interferon group,and the results of the meta-analysis showed that DAA and interferon had a similar effect on the recurrence rate of HCV-related HCC(HR=0.85,95%CI:0.64-1.15,P=0.298).Conclusion Both interferon and DAA can significantly reduce the recurrence risk of HCV-related HCC after curative treatment,with no significant difference between them.