直接抗病毒药物治疗丙型肝炎病毒后肝细胞癌的发生或复发:系统评价和Meta分析

The occurrence or recurrence of hepatocellular carcinoma after hepatitis c virus therapy with direct-acting antivirals: systematic reviews and Meta-analyses

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DOI 10.12208/j.ijcr.20250566
刊名
International Journal of Clinical Research
年,卷(期) 2025, 9(12)
作者
作者单位

1 河南科技大学临床医学院,河南科技大学第一附属医院急诊科 河南洛阳 2 河南科技大学临床医学院,河南科技大学第一附属医院,河南科技大学肿瘤研究所,河南省肿瘤表观遗传重点实验室 河南洛阳
3 武汉大学人民医院感染科 湖北武汉

摘要
背景与目的 直接抗病毒药物(direct-acting antivirals, DAAs)治疗丙型肝炎病毒(hepatitis C virus, HCV)后,肝细胞癌(hepatocellular carcinoma, HCC)的发生或复发风险存在争议。本研究通过Meta分析评估接受直接抗病毒药物治疗患者的肝细胞癌发生或复发特征。方法 检索截至2024年12月31日发表在PubMed、Embase和Web of Science数据库中的相关文献,采用随机效应模型Meta分析计算肝细胞癌的发生或复发率的综合估计值。结果 共纳入78项研究(140614例患者),其中50项研究涉及肝细胞癌发生(136689例患者,前瞻性19项、回顾性29项、回顾-前瞻性1项、观察性1项),42项研究涉及肝细胞癌复发(3925例患者,前瞻性14项、回顾性25项、回顾-前瞻性2项、观察性1项)。在肝细胞癌发生的研究中,合并肝细胞癌发生率为3%(95%置信区间3%-4%);在肝细胞癌复发的研究中,合并肝细胞癌复发率为32%(95%置信区间26%-38%)。多变量方差分析显示,接受直接抗病毒药物治疗的患者与接受干扰素治疗或未治疗的患者相比,肝细胞癌的发生或复发率相近甚至更低。结论 现有数据表明,直接抗病毒药物治疗后肝细胞癌的发生或复发率处于可接受范围。与接受干扰素治疗或未治疗的患者相比,直接抗病毒药物治疗与肝细胞癌发生或复发的风险相近。我们建议对晚期肝病和肝细胞癌高风险患者加强病毒清除后的监测。
Abstract
Background and Aims The risk of hepatocellular carcinoma (HCC) occurrence or recurrence after treatment of hepatitis C virus (HCV) with direct-acting antivirals (DAAs) remains controversial. We performed a meta-analysis to evaluate the occurrence or recurrence characteristics of HCC in DAAs-treated patients. Methods A search was conducted for reports published in PubMed, Embase and Web of Science up to December 31, 2024. Random-effects meta-analyses were performed to determine composite estimates of HCC incidence or recurrence rate. Results A total of 78 studies (n = 140614 patients), including 50 studies on HCC occurrence (n = 136689 patients, prospective = 19, retrospective = 29, retrospective-prospective = 1, observational = 1), and 42 studies on HCC recurrence (n=3925 patients prospective=14, retrospective=25 and retrospective-prospective=2, observational=1). In the studies with HCC occurrence, the combined HCC incidence was 3% (95%CI 3-4%), and in the studies with HCC recurrence, the combined HCC recurrence rate was 32% (95%CI 26-38%). In multivariate analysis of variance, HCC incidence or recurrence rates were similar or even lower in patients treated with DAAs than in patients treated with IFN or untreated. Conclusion Current data suggest an acceptable rate of HCC incidence or recurrence after DAAs therapy. DAAs treatment was associated with a similar risk of HCC occurrence or recurrence compared with interferon-treated or untreated patients. We recommend enhanced implementation of post-eradication surveillance of viral infection in patients with advanced liver disease and higher risk of HCC.
关键词
直接抗病毒药物;肝细胞癌;丙型肝炎病毒;发生;复发
KeyWord
Direct-acting antivirals; Hepatocellular carcinoma; Hepatitis C virus; Occurrence; Recurrence
基金项目
页码 9-33
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王钰鲲,, 杨豪洁. 直接抗病毒药物治疗丙型肝炎病毒后肝细胞癌的发生或复发:系统评价和Meta分析 [J]. 国际临床研究杂志. 2025; 9; (12). 9 - 33.

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