A Critical Evaluation of the Preventive Effect of Antiviral Therapy on the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C or B: A Novel Approach by Using Meta-Regression

Oncology, 04/27/2012

Antiviral therapy can reduce 3– and 5–year cumulative incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC) or B (CHB).

Methods

  • The authors conducted a systemic review and meta–analysis of published randomized controlled trials (RCTs) and cohort studies (CSs) up to December 2010.
  • Preventive efficacy was measured as absolute reduction in 3– and 5–year cumulative incidence of HCC with antiviral therapy.
  • Predictors for efficacy were identified by using meta–regression.

Results

  • Twenty–two studies (5 RCTs; 17 CSs) were included for analysis.
  • Antiviral therapy reduced 5–year cumulative incidence of HCC by 7.8% (95% CI 4.6–11.1; p < 0.0001) in patients with CHC and by 7.1% (95% CI 4.1–10.2; p < 0.0001) in patients with CHB.
  • The efficacy was significant as early as 3 years after antiviral therapy.
  • While adjusting for available study–level, patient and virological factors, RCT and higher sustained virological response were identified as pertinent predictors of superior preventive efficacy in patients with CHC, whereas lower hepatitis B virus e antigen seropositivity was identified in patients with CHB.
  • Antiviral therapy did not result in differential preventive efficacy between cirrhotic and noncirrhotic patients with CHC or CHB.

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