直接抗病毒药物改善HCV相关肝细胞癌患者远期预后效果的Meta分析

周荃; 杨丽晖; 蒋芳清

doi:10.3969/j.issn.1001-5256.2021.08.018

直接抗病毒药物改善HCV相关肝细胞癌患者远期预后效果的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.08.018

长沙市第一医院，长沙 410000

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：周荃负责提出研究选题，设计研究方案，实施研究过程，采集整理数据，起草、修订、终审论文；杨丽晖负责调研整理文献，设计论文框架；蒋芳清负责统计分析，指导性支持。

详细信息

通信作者:
蒋芳清，478772806@qq.com

中图分类号: R512.63;R735.7
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出版历程
- 收稿日期: 2020-12-01
- 录用日期: 2021-02-03
- 出版日期: 2021-08-20

Long-term prognosis of patients with hepatitis C virus-related hepatocellular carcinoma receiving direct-acting antiviral: A Meta-analysis

The First Hospital of Changsha, Changsha 410000, China

摘要

摘要: 目的系统的评价全口服直接抗病毒药物(DAA)与无DAA(NDAA)方案对于丙型肝炎相关肝细胞癌(HCC)患者在无复发生存率、HCC复发率、全因死亡率、肝脏相关病死率方面的差异。方法检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Pubmed、Embase、Cochrane Library七大数据库于2020年12月之前公开发表的DAA治疗丙型肝炎相关HCC患者的临床队列研究，并进行质量评价与Meta分析。结果本研究共纳入10个临床队列研究，共计3108例患者。Meta分析结果显示：与NDAA方案相比，DAA治疗能够显著提高丙型肝炎相关HCC患者的无复发生存率(RR=1.38，95%CI：1.10~1.72，P=0.005)，降低HCC复发率(RR=0.52，95%CI：0.42~0.63，P＜0.000 01)、全因死亡率(RR=0.42，95%CI：0.32~0.55，P＜0.000 01)及肝脏相关病死率(RR=0.37，95%CI：0.18~0.76，P=0.007)。结论对于丙型肝炎相关HCC患者使用DAA治疗是有益且安全的。
- 丙型肝炎 /
- 直接抗病毒药物 /
- 癌, 肝细胞 /
- Meta分析(主题)
Abstract: Objective To systematically evaluate the difference in recurrence-free survival rate, hepatocellular carcinoma (HCC) recurrence rate, all-cause mortality rate, and liver-related mortality rate between hepatitis C-related HCC patients receiving oral direct-acting antiviral (DAA) and those receiving non-DAA (NDAA) treatment regimen. Methods CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, and Cochrane Library were searched for Cohort studies of DAA in the treatment of hepatitis C-related HCC patients published before December 2020, and quality assessment and meta-analysis were performed. Results A total of 10 cohort studies were included in this study, with 3108 patients in total. The meta-analysis showed that compared with NDAA regimen, DAA treatment significantly increased recurrence-free survival rate (risk ratio [RR]=1.38, 95% confidence interval [CI]: 1.10-1.72, P=0.005) and significantly reduced HCC recurrence rate (RR=0.52, 95%CI: 0.42-0.63, P < 0.000 01), all-cause mortality rate (RR=0.42, 95%CI: 0.32-0.55, P < 0.000 01), and liver-related mortality rate (RR=0.37, 95%CI: 0.18-0.76, P=0.007) in hepatitis C-related HCC patients. Conclusion DAA treatment is beneficial and safe for hepatitis C-related HCC patients.
- Hepatitis C /
- Direct-Acting Antiviral /
- Carcinoma, Hepatocellular /
- Meta-Analysis as Topic

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图 1 文献筛选流程图

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图 2 无复发生存率的Meta分析

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图 3 无复发生存率不同年龄的亚组分析

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图 4 HCC复发率的Meta分析

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图 5 全因死亡率的Meta分析

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图 6 肝脏相关病死率的Meta分析

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图 7 无复发生存率漏斗图

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表 1 纳入研究的基本情况

第一作者	年份	总样本量	例数(E/C)	男/女(例)	种族	国籍	年龄(岁)	随访时间	结局指标	NOS评分
Warzyszyńska等^[11]	2017	51	19/32	33/18	—	波兰	58.5(36~67)	4年	①②	8
Singal等^[12]	2019	797	383/414	E: 276/107 C: 320/94	非西班牙裔白人	美国、加拿大	E: 62.1(58.6~66.1) C: 61.2(57.0~65.0)	4年	①②③④	7
Cabibbo等^[13]	2019	204	102/102	E: 63/39 C: 65/37	—	意大利	E: 71.3±9.5 C: 71.9±8.8	3年	①②③	6
Kamp等^[14]	2019	368	123/245	E: 99/24 C: 202/43	—	—	62.8±10.2	11年	①	5
Preda等^[15]	2019	44	22/22	E: 13/12 C: 9/10	—	—	64(51~77)	44个月	②	7
Dang等^[16]	2020	642	321/321	E: 197/124 C: 194/127	—	美国、日本、韩国、中国台湾	E: 66.39±9.09 C: 65.92±9.13	5年	①③④	6
Kuo等^[17]	2019	240	80/160	E: 51/29 C: 102/58	—	中国台湾	E: 66 C: 66	12年	①②	6
The ANRS collaborativestudy group^[18]	2016	267	189/78	E: 147/42 C: 57/21	—	法国	E: 62±9 C: 66±10	3年	②	5
Ikeda等^[19]	2017	178	89/89	E: 52/37 C: 52/37	—	日本	E: 71(39~85) C: 71(45~85)	2年	②	7
Ochi等^[20]	2020	317	56/261	E: 31/25 C: 157/104	—	日本	E: 71(56~87) C: 75(46~91)	2年	①②③	7
注：E，试验组，C，对照组；①无复发生存率；②HCC复发率；③全因死亡率；④肝脏相关病死率；—，未提及。

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