Impact of antiviral therapy on hepatocellular carcinoma and mortality in patients with chronic hepatitis C: systematic review and meta-analysis

Abstract

BackgroundThe long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy. This study aimed to assess the impact of antiviral treatment on the development of HCC and mortality in patients with chronic HCV infection.MethodsA systematic review was conducted for studies that evaluated the antiviral efficacy for patients with chronic hepatitis C or assessed the development of HCC or mortality between SVR (sustained virologic response) and non-SVR patients. The methodological quality of the enrolled publications was evaluated using Risk of Bias table or Newcastle-Ottawa scale. Random-effect model meta-analyses and meta-regression were performed. Publication bias was assessed.ResultsIn total, 59 studies (4 RCTs, 15 prospective and 40 retrospective cohort studies) were included. Antiviral treatment was associated with reduced development of HCC (vs. no treatment; OR 0.392, 95% CI 0.275–0.557), and this effect was intensified when SVR was achieved (vs. no SVR, OR: 0.203, 95% CI 0.164–0.251). Antiviral treatment was associated with lower all-cause mortality (vs. no treatment; OR 0.380, 95% CI 0.295–0.489) and liver-specific mortality (OR 0.363, 95% CI 0.260–0.508). This rate was also intensified when SVR was achieved [all-cause mortality (vs. no SVR, OR 0.255, 95% CI 0.199–0.326), liver-specific mortality (OR 0.126, 95% CI 0.094–0.169)]. Sensitivity analyses revealed robust results, and a small study effect was minimal.ConclusionsIn patients with chronic hepatitis C, antiviral therapy can reduce the development of HCC and mortality, especially when SVR is achieved.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0606-9) contains supplementary material, which is available to authorized users.

Statin and the risk of hepatocellular carcinoma in patients with hepatitis B virus or hepatitis C virus infection: a meta-analysis

“…Our study has limitations Firstly, significant heterogeneity was found for the meta-analysis. Although stratified analyses were performed to evaluate the patient and statin prescription characteristics on the outcome, we could not exclude some other study characteristics that may also contribute to the heterogeneity, such as concurrent medications including antiviral agents [39] and metformin [40]. Both have been indicated to confer anticancer effects.…”

Statin use and the prognosis of patients with hepatocellular carcinoma: a meta-analysis

“…First, significant heterogeneity exists among the included studies. Although subgroup analyses were performed to evaluate HBV status, tumor stages, and treatment options on the association between statin use and prognosis in HCC patients, we could not exclude that other study characteristics may also contribute to the heterogeneity, such as concurrent medications including antiviral agents [34] and use of metformin [35], which have both been indicated to confer anticancer effects. Furthermore, as mentioned above, due to the limited datasets available, results of subgroup analyses for the association between statin use and overall mortality in stage IV HCC patients and those received curative therapies should be cautious interpreted.…”

The benefits of hepatitis C virus cure: Every rose has thorns

“…Another systematic review collected 59 studies (4 RCTs, 15 prospective and 40 retrospective cohort studies) . It also showed that SVR was associated with a decrease in liver‐specific mortality (OR 0.126, 95% CI: 0.094‐0.169) and, most interestingly, in all‐cause mortality too (SVR vs no SVR, OR 0.255, 95% CI: 0.199‐0.326).…”