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Meta-Analysis
. 2017 Apr 4;17(1):46.
doi: 10.1186/s12876-017-0606-9.

Impact of antiviral therapy on hepatocellular carcinoma and mortality in patients with chronic hepatitis C: systematic review and meta-analysis

Chang Seok Bang  1 , Il Han Song  2
Affiliations
Meta-Analysis

Impact of antiviral therapy on hepatocellular carcinoma and mortality in patients with chronic hepatitis C: systematic review and meta-analysis

Chang Seok Bang et al. BMC Gastroenterol. .

Abstract

Background: The long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy. This study aimed to assess the impact of antiviral treatment on the development of HCC and mortality in patients with chronic HCV infection.

Methods: A systematic review was conducted for studies that evaluated the antiviral efficacy for patients with chronic hepatitis C or assessed the development of HCC or mortality between SVR (sustained virologic response) and non-SVR patients. The methodological quality of the enrolled publications was evaluated using Risk of Bias table or Newcastle-Ottawa scale. Random-effect model meta-analyses and meta-regression were performed. Publication bias was assessed.

Results: In total, 59 studies (4 RCTs, 15 prospective and 40 retrospective cohort studies) were included. Antiviral treatment was associated with reduced development of HCC (vs. no treatment; OR 0.392, 95% CI 0.275-0.557), and this effect was intensified when SVR was achieved (vs. no SVR, OR: 0.203, 95% CI 0.164-0.251). Antiviral treatment was associated with lower all-cause mortality (vs. no treatment; OR 0.380, 95% CI 0.295-0.489) and liver-specific mortality (OR 0.363, 95% CI 0.260-0.508). This rate was also intensified when SVR was achieved [all-cause mortality (vs. no SVR, OR 0.255, 95% CI 0.199-0.326), liver-specific mortality (OR 0.126, 95% CI 0.094-0.169)]. Sensitivity analyses revealed robust results, and a small study effect was minimal.

Conclusions: In patients with chronic hepatitis C, antiviral therapy can reduce the development of HCC and mortality, especially when SVR is achieved.

Keywords: Antiviral therapy; Chronic hepatitis C; Hepatocellular carcinoma; Mortality; Sustained virologic response.

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Figures

Fig. 1
Fig. 1
Flow diagram for identification of relevant studies
Fig. 2
Fig. 2
Efficacy of antiviral treatment on the development of HCC in patients with CHC. The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). HCC, hepatocellular carcinoma; CHC, chronic hepatitis C
Fig. 3
Fig. 3
Efficacy of antiviral treatment on all-cause mortality in patients with CHC. The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). CHC, chronic hepatitis C
Fig. 4
Fig. 4
Efficacy of SVR on the development of HCC in patients with CHC. The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). SVR, sustained virologic response; HCC, hepatocellular carcinoma; CHC, chronic hepatitis C
Fig. 5
Fig. 5
Efficacy of SVR on all-cause mortality in patients with CHC. The size of each square is proportional to the study’s weight. Diamond is the summary estimate from the pooled studies (random effect model). SVR, sustained virologic response; CHC, chronic hepatitis C
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