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Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis.
Sapena, Victor; Enea, Marco; Torres, Ferran; Celsa, Ciro; Rios, Jose; Rizzo, Giacomo Emanuele Maria; Nahon, Pierre; Mariño, Zoe; Tateishi, Ryosuke; Minami, Tatsuya; Sangiovanni, Angelo; Forns, Xavier; Toyoda, Hidenori; Brillanti, Stefano; Conti, Fabio; Degasperi, Elisabetta; Yu, Ming-Lung; Tsai, Pei-Chien; Jean, Kevin; El Kassas, Mohamed; Shousha, Hend Ibrahim; Omar, Ashraf; Zavaglia, Claudio; Nagata, Hiroko; Nakagawa, Mina; Asahina, Yasuhiro; Singal, Amit G; Murphy, Caitlin; Kohla, Mohamed; Masetti, Chiara; Dufour, Jean-François; Merchante, Nicolas; Cavalletto, Luisa; Chemello, Liliana Lc; Pol, Stanislas; Crespo, Javier; Calleja, Jose Luis; Villani, Rosanna; Serviddio, Gaetano; Zanetto, Alberto; Shalaby, Sarah; Russo, Francesco Paolo; Bielen, Rob; Trevisani, Franco; Cammà, Calogero; Bruix, Jordi; Cabibbo, Giuseppe; Reig, Maria.
  • Sapena V; Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, CIBEREHD, Hospital Clinic de Barcelona, Barcelona, Spain.
  • Enea M; Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy.
  • Torres F; Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain.
  • Celsa C; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
  • Rios J; Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy.
  • Rizzo GEM; Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Sicilia, Italy.
  • Nahon P; Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain.
  • Mariño Z; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
  • Tateishi R; Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy.
  • Minami T; AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", F-75000, Bondy, France.
  • Sangiovanni A; Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD, Barcelona, Spain.
  • Forns X; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Toyoda H; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Brillanti S; Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy.
  • Conti F; CRC "A.M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
  • Degasperi E; Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD, Barcelona, Spain.
  • Yu ML; Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
  • Tsai PC; Department of Medical and Surgical Sciences (DIMEC), Research Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy.
  • Jean K; Department of Medical and Surgical Sciences (DIMEC), Research Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy.
  • El Kassas M; Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy.
  • Shousha HI; CRC "A.M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
  • Omar A; Hepatobiliary Division, Department of Internal Medicine and Hepatitis, Center Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  • Zavaglia C; Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  • Nagata H; Hepatobiliary Division, Department of Internal Medicine and Hepatitis, Center Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
  • Nakagawa M; Laboratoire MESuRS (EA 4628), Conservatoire National Des Arts et Métiers, Paris, France.
  • Asahina Y; Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France.
  • Singal AG; Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt.
  • Murphy C; Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt.
  • Kohla M; Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt.
  • Masetti C; Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milano, Lombardia, Italy.
  • Dufour JF; Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
  • Merchante N; Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
  • Cavalletto L; Institute of Education, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
  • Chemello LL; Department of Gastroenterology and Hepatology, Liver Disease Control, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
  • Pol S; Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
  • Crespo J; Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
  • Calleja JL; Hepatology, National Liver Institute, Shebin El-Kom, Egypt.
  • Villani R; Liver and Transplant Unit, Policlinico Tor Vergata, Rome, Italy.
  • Serviddio G; Hepatology, Department of Clinical Research, University Clinic for Visceral Surgery and Medicine Inselspital, Bern, Switzerland.
  • Zanetto A; Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland.
  • Shalaby S; Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain.
  • Russo FP; Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Center for Liver Diseases, Padova, Italy.
  • Bielen R; Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Center for Liver Diseases, Padova, Italy.
  • Trevisani F; l'Agence de recherche ANRS (France REcherche Nord&Sud Sida-HIV Hépatites), Paris, France.
  • Cammà C; Gastroenterology and Hepatology Service, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
  • Bruix J; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain.
  • Cabibbo G; Gastroenterology and Hepatology, IDIPHIM, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
  • Reig M; (CIBEREHD), Instituto de Salud Carlos III, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Madrid, Spain.
Gut ; 71(3): 593-604, 2022 03.
Article en En | MEDLINE | ID: mdl-33741640
ABSTRACT

OBJECTIVE:

The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration.

DESIGN:

We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson.

RESULTS:

Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1).

CONCLUSION:

Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Antivirales / Carcinoma Hepatocelular / Neoplasias Hepáticas / Recurrencia Local de Neoplasia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Año: 2022 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Antivirales / Carcinoma Hepatocelular / Neoplasias Hepáticas / Recurrencia Local de Neoplasia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Año: 2022 Tipo del documento: Article