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.
A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma / Cabibbo, G.; Petta, S.; Barbara, M.; Missale, G.; Virdone, R.; Caturelli, E.; Piscaglia, F.; Morisco, F.; Colecchia, A.; Farinati, F.; Giannini, E.; Trevisani, F.; Craxi, A.; Colombo, M.; Camma, C.; Bucci, L.; Zoli, M.; Garuti, F.; Lenzi, B.; Biselli, M.; Caraceni, P.; Cucchetti, A.; Gramenzi, A.; Granito, A.; Magalotti, D.; Serra, C.; Negrini, G.; Napoli, L.; Salvatore, V.; Benevento, F.; Benvegnu, L.; Gazzola, A.; Murer, F.; Pozzan, C.; Vanin, V.; Moscatelli, A.; Pellegatta, G.; Picciotto, A.; Savarino, V.; Ciccarese, F.; Del Poggio, P.; Olmi, S.; de Matthaeis, N.; Balsamo, M. D. M. C.; Vavassori, E.; Roselli, P.; Dell'Isola, S.; Ialungo, A. M.; Rastrelli, E.; Attardo, S.; Rossi, M.; Costantino, A.; Affronti, A.; Affronti, M.; Mascari, M.; Felder, M.; Mega, A.; Gasbarrini, A.; Pompili, M.; Rinninella, E.; Sacco, R.; Mismas, V.; Foschi, F. G.; Dall'Aglio, A. C.; Feletti, V.; Lanzi, A.; Cappa, F. M.; Neri, E.; Stefanini, G. F.; Tamberi, S.; Olivani, A.; Biasini, E.; Nardone, G.; Guarino, M.; Svegliati-Baroni, G.; Ortolani, A.; Masotto, A.; Marchetti, F.; Valerio, M.; Marra, F.; Aburas, S.; Inghilesi, A. L.; Cappelli, A.; Golfieri, R.; Mosconi, C.; Renzulli, M.; Coccoli, P.; Zamparelli, M. S.. - In: LIVER INTERNATIONAL. - ISSN 1478-3223. - 37:8(2017), pp. 1157-1166. [10.1111/liv.13357]
A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma
Missale G.;
2017-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
