Maja Thiele1, Agustín Albillos2, Rozeta Abazi1, Reiner Wiest3, Lise L Gluud4, Aleksander Krag1. 1. Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark. 2. Department of Gastroenterology and Hepatology, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institute of Health Carlos III, University Hospital Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain. 3. Department for Visceral Surgery and Medicine, University Hospital Bern, Bern, Switzerland. 4. Gastro unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Abstract
BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomized trials. METHODS: Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I(2) as a measure of heterogeneity. Subgroup, sensitivity, regression and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing. RESULTS: Twenty-three randomized trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow-up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC vs 65 of 697 controls (risk difference -0.026; 95% CI-0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I(2) = 7%) or evidence of small study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC-related mortality (RD -0.011; 95% CI -0.040 to 0.017). CONCLUSIONS: Non-selective beta-blockers may prevent HCC in patients with cirrhosis.
BACKGROUND & AIMS: Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomized trials. METHODS: Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I(2) as a measure of heterogeneity. Subgroup, sensitivity, regression and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing. RESULTS: Twenty-three randomized trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow-up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC vs 65 of 697 controls (risk difference -0.026; 95% CI-0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I(2) = 7%) or evidence of small study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC-related mortality (RD -0.011; 95% CI -0.040 to 0.017). CONCLUSIONS: Non-selective beta-blockers may prevent HCC in patients with cirrhosis.
Authors: Marisa Coelho; Cátia Soares-Silva; Daniela Brandão; Franca Marino; Marco Cosentino; Laura Ribeiro Journal: J Cancer Res Clin Oncol Date: 2016-10-05 Impact factor: 4.553
Authors: F Edward Boas; Etay Ziv; Hooman Yarmohammadi; Karen T Brown; Joseph P Erinjeri; Constantinos T Sofocleous; James J Harding; Stephen B Solomon Journal: J Vasc Interv Radiol Date: 2017-05-17 Impact factor: 3.464
Authors: Barbara R Tschida; Nuri A Temiz; Timothy P Kuka; Lindsey A Lee; Jesse D Riordan; Carlos A Tierrablanca; Robert Hullsiek; Sandra Wagner; Wendy A Hudson; Michael A Linden; Khalid Amin; Pauline J Beckmann; Rachel A Heuer; Aaron L Sarver; Ju Dong Yang; Lewis R Roberts; Joseph H Nadeau; Adam J Dupuy; Vincent W Keng; David A Largaespada Journal: Cancer Res Date: 2017-10-09 Impact factor: 12.701
Authors: A Hüsing-Kabar; T Meister; M Köhler; W Domschke; I Kabar; C Wilms; B Hild; H H Schmidt; H S Heinzow Journal: United European Gastroenterol J Date: 2017-09-20 Impact factor: 4.623