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

Piscaglia, Fabio;Colecchia, Antonio;Trevisani, Franco;Bucci, Laura;Zoli, Marco;Garuti, Francesca;Lenzi, Barbara;Biselli, Maurizio;Caraceni, Paolo;Cucchetti, Alessandro;Gramenzi, Annagiulia;Granito, Alessandro;Magalotti, Donatella;Serra, Carla;Negrini, Giulia;Napoli, Lucia;Salvatore, Veronica;Benevento, Francesca;ROSSI, MARGHERITA;Costantino, Andrea;Feletti, Valentina;Cappa, Federica Mirici;Stefanini, Giuseppe Francesco;Tamberi, Stefano;Cappelli, Alberta;Golfieri, Rita;Mosconi, Cristina;Renzulli, Matteo;
2017

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.
Cabibbo, Giuseppe; Petta, Salvatore; Barbã ra, Marco; Missale, Gabriele; Virdone, Roberto; Caturelli, Eugenio; Piscaglia, Fabio; Morisco, Filomena; Colecchia, Antonio; Farinati, Fabio; Giannini, Edoardo; Trevisani, Franco; Craxã¬, Antonio; Colombo, Massimo; Cammã , Calogero; Bucci, Laura; Zoli, Marco; Garuti, Francesca; Lenzi, Barbara; Biselli, Maurizio; Caraceni, Paolo; Cucchetti, Alessandro; Gramenzi, Annagiulia; Granito, Alessandro; Magalotti, Donatella; Serra, Carla; Negrini, Giulia; Napoli, Lucia; Salvatore, Veronica; Benevento, Francesca; Benvegnã¹, Luisa; Gazzola, Alessia; Murer, Francesca; Pozzan, Caterina; Vanin, Veronica; Moscatelli, Alessandro; Pellegatta, Gaia; Picciotto, Antonino; Savarino, Vincenzo; Ciccarese, Francesca; Del Poggio, Paolo; Olmi, Stefano; de Matthaeis, Nicoletta; Balsamo, Mariella Di Marco Claudia; Vavassori, Elena; Roselli, Paola; Dellâ isola, Serena; Ialungo, Anna Maria; Rastrelli, Elena; Attardo, Simona; Rossi, Margherita; Costantino, Andrea; Affronti, Andrea; Affronti, Marco; Mascari, Marta; Felder, Martina; Mega, Andrea; Gasbarrini, Antonio; Pompili, Maurizio; Rinninella, Emanuele; Sacco, Rodolfo; Mismas, Valeria; Foschi, Francesco Giuseppe; Dallâ aglio, Anna Chiara; Feletti, Valentina; Lanzi, Arianna; Federica Mirici, Cappa; Neri, Elga; Stefanini, Giuseppe Francesco; Tamberi, Stefano; Olivani, Andrea; Biasini, Elisabetta; Nardone, Gerardo; Guarino, Maria; Svegliati-Baroni, Gialuca; Ortolani, Alessio; Masotto, Alberto; Marchetti, Fabiana; Valerio, Matteo; Marra, Fabio; Aburas, Sami; Inghilesi, Andrea L; Cappelli, Alberta; Golfieri, Rita; Mosconi, Cristina; Renzulli, Matteo; Coccoli, Piero; Zamparelli, Marco Sanduzzi
File in questo prodotto:
Eventuali allegati, non sono esposti

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/619393
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 23
  • Scopus 54
  • ???jsp.display-item.citation.isi??? 49
social impact