Giuseppe Cabibbo1, Salvatore Petta1, Marco Barbàra1, Gabriele Missale2, Roberto Virdone3, Eugenio Caturelli4, Fabio Piscaglia5, Filomena Morisco6, Antonio Colecchia7, Fabio Farinati8, Edoardo Giannini9, Franco Trevisani10, Antonio Craxì1, Massimo Colombo11, Calogero Cammà1. 1. Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy. 2. Unit of Infectious Diseases and Hepatology, Teaching Hospital-University of Parma, Italy. 3. Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. 4. Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy. 5. Division of Internal Medicine, Department of Medical and Surgical Sciences, Alma Mater Studiorum, Bologna, Italy. 6. Division of Gastroenterology, Department of Medicine and Surgery, University of Naples Federico II, Italy. 7. Department of Medical and Surgical Sciences, University of Bologna, Italy. 8. Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy. 9. Gastroenterology Unit, Department of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino IST, Genoa, Italy. 10. Division of Semeiotics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, Bologna, Italy. 11. Humanitas Clinical and Research Center, Rozzano, Italy.
Abstract
BACKGROUND & AIMS: Determining risk for recurrence or survival after curative resection or ablation in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is important for stratifying patients according to expected outcomes in future studies of adjuvant therapy in the era of direct-acting antivirals (DAAs). The aims of this meta-analysis were to estimate the recurrence and survival probabilities of HCV-related early HCC following complete response after potentially curative treatment and to identify predictors of recurrence and survival. METHODS: Studies reporting time-dependent outcomes (HCC recurrence or death) after potentially curative treatment of HCV-related early HCC were identified in MEDLINE through May 2016. Data on patient populations and outcomes were extracted from each study by three independent observers and combined using a distribution-free summary survival curve. Primary outcomes were actuarial probabilities of recurrence and survival. RESULTS: Eleven studies met the inclusion criteria. Pooled estimates of actuarial recurrence rates were 7.4% at 6 months and 47.0% at 2 years. Pooled estimates of actuarial survival rates were 79.8% at 3 years and 58.6% at 5 years. Heterogeneity among studies was highly significant for all outcomes. By univariate meta-regression analyses, lower serum albumin, randomized controlled trial study design and follow-up were independently associated with higher recurrence risk, whereas tumour size and alpha-foetoprotein levels were associated with higher mortality. CONCLUSIONS: This meta-analysis showed that recurrence risk and survival are extremely variable in patients with successfully treated HCV-related HCC, providing a useful benchmark for indirect comparisons of the benefits of DAAs and for a correct design of randomized controlled trials in the adjuvant setting.
BACKGROUND & AIMS: Determining risk for recurrence or survival after curative resection or ablation in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is important for stratifying patients according to expected outcomes in future studies of adjuvant therapy in the era of direct-acting antivirals (DAAs). The aims of this meta-analysis were to estimate the recurrence and survival probabilities of HCV-related early HCC following complete response after potentially curative treatment and to identify predictors of recurrence and survival. METHODS: Studies reporting time-dependent outcomes (HCC recurrence or death) after potentially curative treatment of HCV-related early HCC were identified in MEDLINE through May 2016. Data on patient populations and outcomes were extracted from each study by three independent observers and combined using a distribution-free summary survival curve. Primary outcomes were actuarial probabilities of recurrence and survival. RESULTS: Eleven studies met the inclusion criteria. Pooled estimates of actuarial recurrence rates were 7.4% at 6 months and 47.0% at 2 years. Pooled estimates of actuarial survival rates were 79.8% at 3 years and 58.6% at 5 years. Heterogeneity among studies was highly significant for all outcomes. By univariate meta-regression analyses, lower serum albumin, randomized controlled trial study design and follow-up were independently associated with higher recurrence risk, whereas tumour size and alpha-foetoprotein levels were associated with higher mortality. CONCLUSIONS: This meta-analysis showed that recurrence risk and survival are extremely variable in patients with successfully treated HCV-related HCC, providing a useful benchmark for indirect comparisons of the benefits of DAAs and for a correct design of randomized controlled trials in the adjuvant setting.
Authors: Massimo Andreoni; Sergio Babudieri; Savino Bruno; Massimo Colombo; Anna L Zignego; Vito Di Marco; Giovanni Di Perri; Carlo F Perno; Massimo Puoti; Gloria Taliani; Erica Villa; Antonio Craxì Journal: Infection Date: 2017-11-02 Impact factor: 3.553
Authors: Ahmed Kamal; Amr Aly Abd Elmoety; Yousri Abdelmeguid Rostom; Mohamed Said Shater; Sameh Aldesoky Lashen Journal: Clin Exp Hepatol Date: 2021-03-11