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Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy
Summary Background Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct‐acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response. Aim Characterize HCC recurrence patterns...
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| Published in: | Alimentary pharmacology & therapeutics 2018-07, Vol.48 (2), p.127-137 |
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| container_issue | 2 |
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| container_title | Alimentary pharmacology & therapeutics |
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| creator | Saraiya, N. Yopp, A. C. Rich, N. E. Odewole, M. Parikh, N. D. Singal, A. G. |
| description | Summary
Background
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct‐acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response.
Aim
Characterize HCC recurrence patterns after DAA therapy.
Methods
Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines.
Results
Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%‐30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%‐28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA‐treated and interferon‐treated or untreated patients found similar recurrence among DAA‐treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow‐up.
Conclusions
Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies. |
| doi_str_mv | 10.1111/apt.14823 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6019180</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2058553976</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4433-5831e540fa734a54b0b6bb1e40fc27c283eb433d4f6f9c914e910359260c3b963</originalsourceid><addsrcrecordid>eNp1kctu1DAYRi0EotOBBS-AIrGhi7S-J2ZRqaq4SZVAoqwtx_On4yqJg-3MKKx4BJ6RJ8FhSgVIeGPZPj767A-hZwSfkjzOzJhOCa8pe4BWhElRUszkQ7TCVKqS1oQdoeMYbzHGssL0MTqiqhYEK7ZCXz_NMUFvkrNFgJ2DfbF3aVv0kMyPb9_NYLo5uvgqH9opBBgsFL4ttjCa5C103dSZUFgTrBt8b4rWd53fu-Gm2Lh8JS0Om5a1GZLbuWC6Im0hmHF-gh61povw9G5eo89vXl9fviuvPrx9f3lxVVrOGStFzQgIjltTMW4Eb3Ajm4ZA3rG0srRm0GRuw1vZKqsIB0UwE4pKbFmjJFuj84N3nJoeNhaGlFPoMbjehFl74_TfJ4Pb6hu_0xITRWqcBS_vBMF_mSAm3bu4vN0M4KeoKeaVokLkAtboxT_orZ9C_sSFErUQTFVLopMDZYOPMUB7H4ZgvTSqc6P6V6OZff5n-nvyd4UZODsAe9fB_H-Tvvh4fVD-BPCTr5M</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2058553976</pqid></control><display><type>article</type><title>Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy</title><source>Wiley</source><creator>Saraiya, N. ; Yopp, A. C. ; Rich, N. E. ; Odewole, M. ; Parikh, N. D. ; Singal, A. G.</creator><creatorcontrib>Saraiya, N. ; Yopp, A. C. ; Rich, N. E. ; Odewole, M. ; Parikh, N. D. ; Singal, A. G.</creatorcontrib><description>Summary
Background
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct‐acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response.
Aim
Characterize HCC recurrence patterns after DAA therapy.
Methods
Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines.
Results
Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%‐30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%‐28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA‐treated and interferon‐treated or untreated patients found similar recurrence among DAA‐treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow‐up.
Conclusions
Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.14823</identifier><identifier>PMID: 29851093</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Carcinoma, Hepatocellular - drug therapy ; Carcinoma, Hepatocellular - epidemiology ; Carcinoma, Hepatocellular - pathology ; Carcinoma, Hepatocellular - virology ; Female ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - drug therapy ; Hepatitis C, Chronic - epidemiology ; Hepatitis C, Chronic - pathology ; Hepatocellular carcinoma ; Humans ; Interferon ; Liver cancer ; Liver Neoplasms - drug therapy ; Liver Neoplasms - epidemiology ; Liver Neoplasms - pathology ; Liver Neoplasms - virology ; Male ; Meta-analysis ; Middle Aged ; Neoplasm Recurrence, Local - epidemiology ; Patients ; Prospective Studies ; Recurrence ; Tumors</subject><ispartof>Alimentary pharmacology & therapeutics, 2018-07, Vol.48 (2), p.127-137</ispartof><rights>2018 John Wiley & Sons Ltd</rights><rights>2018 John Wiley & Sons Ltd.</rights><rights>Copyright © 2018 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4433-5831e540fa734a54b0b6bb1e40fc27c283eb433d4f6f9c914e910359260c3b963</citedby><cites>FETCH-LOGICAL-c4433-5831e540fa734a54b0b6bb1e40fc27c283eb433d4f6f9c914e910359260c3b963</cites><orcidid>0000-0002-5874-9933 ; 0000-0002-1172-3971</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.14823$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.14823$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,315,786,790,891,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29851093$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saraiya, N.</creatorcontrib><creatorcontrib>Yopp, A. C.</creatorcontrib><creatorcontrib>Rich, N. E.</creatorcontrib><creatorcontrib>Odewole, M.</creatorcontrib><creatorcontrib>Parikh, N. D.</creatorcontrib><creatorcontrib>Singal, A. G.</creatorcontrib><title>Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct‐acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response.
Aim
Characterize HCC recurrence patterns after DAA therapy.
Methods
Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines.
Results
Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%‐30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%‐28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA‐treated and interferon‐treated or untreated patients found similar recurrence among DAA‐treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow‐up.
Conclusions
Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.</description><subject>Adult</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Carcinoma, Hepatocellular - drug therapy</subject><subject>Carcinoma, Hepatocellular - epidemiology</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Carcinoma, Hepatocellular - virology</subject><subject>Female</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatitis C, Chronic - epidemiology</subject><subject>Hepatitis C, Chronic - pathology</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Interferon</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - drug therapy</subject><subject>Liver Neoplasms - epidemiology</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver Neoplasms - virology</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Tumors</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1DAYRi0EotOBBS-AIrGhi7S-J2ZRqaq4SZVAoqwtx_On4yqJg-3MKKx4BJ6RJ8FhSgVIeGPZPj767A-hZwSfkjzOzJhOCa8pe4BWhElRUszkQ7TCVKqS1oQdoeMYbzHGssL0MTqiqhYEK7ZCXz_NMUFvkrNFgJ2DfbF3aVv0kMyPb9_NYLo5uvgqH9opBBgsFL4ttjCa5C103dSZUFgTrBt8b4rWd53fu-Gm2Lh8JS0Om5a1GZLbuWC6Im0hmHF-gh61povw9G5eo89vXl9fviuvPrx9f3lxVVrOGStFzQgIjltTMW4Eb3Ajm4ZA3rG0srRm0GRuw1vZKqsIB0UwE4pKbFmjJFuj84N3nJoeNhaGlFPoMbjehFl74_TfJ4Pb6hu_0xITRWqcBS_vBMF_mSAm3bu4vN0M4KeoKeaVokLkAtboxT_orZ9C_sSFErUQTFVLopMDZYOPMUB7H4ZgvTSqc6P6V6OZff5n-nvyd4UZODsAe9fB_H-Tvvh4fVD-BPCTr5M</recordid><startdate>201807</startdate><enddate>201807</enddate><creator>Saraiya, N.</creator><creator>Yopp, A. C.</creator><creator>Rich, N. E.</creator><creator>Odewole, M.</creator><creator>Parikh, N. D.</creator><creator>Singal, A. G.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5874-9933</orcidid><orcidid>https://orcid.org/0000-0002-1172-3971</orcidid></search><sort><creationdate>201807</creationdate><title>Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy</title><author>Saraiya, N. ; Yopp, A. C. ; Rich, N. E. ; Odewole, M. ; Parikh, N. D. ; Singal, A. G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4433-5831e540fa734a54b0b6bb1e40fc27c283eb433d4f6f9c914e910359260c3b963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Carcinoma, Hepatocellular - drug therapy</topic><topic>Carcinoma, Hepatocellular - epidemiology</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Carcinoma, Hepatocellular - virology</topic><topic>Female</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>Hepatitis C, Chronic - epidemiology</topic><topic>Hepatitis C, Chronic - pathology</topic><topic>Hepatocellular carcinoma</topic><topic>Humans</topic><topic>Interferon</topic><topic>Liver cancer</topic><topic>Liver Neoplasms - drug therapy</topic><topic>Liver Neoplasms - epidemiology</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver Neoplasms - virology</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saraiya, N.</creatorcontrib><creatorcontrib>Yopp, A. C.</creatorcontrib><creatorcontrib>Rich, N. E.</creatorcontrib><creatorcontrib>Odewole, M.</creatorcontrib><creatorcontrib>Parikh, N. D.</creatorcontrib><creatorcontrib>Singal, A. G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saraiya, N.</au><au>Yopp, A. C.</au><au>Rich, N. E.</au><au>Odewole, M.</au><au>Parikh, N. D.</au><au>Singal, A. G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2018-07</date><risdate>2018</risdate><volume>48</volume><issue>2</issue><spage>127</spage><epage>137</epage><pages>127-137</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><notes>Funding information</notes><notes>This work was conducted with support from NCI RO1 CA212008 and RO1 CA222900. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><notes>ObjectType-Undefined-3</notes><notes>Drs. Parikh and Singal are co-senior authors</notes><abstract>Summary
Background
Although studies suggest decreased incident hepatocellular carcinoma (HCC) after direct‐acting antivirals (DAA), data are conflicting regarding HCC recurrence and aggressiveness in patients who have a history of HCC with complete response.
Aim
Characterize HCC recurrence patterns after DAA therapy.
Methods
Two reviewers searched MEDLINE and SCOPUS from January 2015 to December 2017 and identified studies evaluating HCC recurrence patterns following DAA therapy. A pooled estimate was calculated using the DerSimonian and Laird method for a random effects model. The study was conducted in accordance with PRISMA guidelines.
Results
Among 24 studies (n = 1820 patients), the proportion of patients with HCC recurrence following DAA therapy ranged from 0% to 59% (pooled estimate 24.4%; 95% CI: 18.4%‐30.4%). Among 11 full text manuscripts, pooled HCC recurrence was 21.9% (95% CI: 16.2%‐28.3%). Factors associated with recurrence included history of prior HCC recurrence and a shorter interval between HCC complete response and DAA initiation. Nine studies comparing DAA‐treated and interferon‐treated or untreated patients found similar recurrence among DAA‐treated patients. Most (77.8%) patients with HCC recurrence were detected at an early tumour stage, of whom 64.7% received curative treatment. Study limitations included heterogeneous cohorts, potential misclassification of HCC absence prior to DAA, ascertainment bias for recurrence, and short durations of follow‐up.
Conclusions
Current data suggest acceptable HCC recurrence rates after DAA therapy, particularly if DAA therapy is delayed at least 6 months after HCC complete response. However, data characterising HCC recurrence after DAA therapy are of limited quality, highlighting the need for high quality prospective studies.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29851093</pmid><doi>10.1111/apt.14823</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-5874-9933</orcidid><orcidid>https://orcid.org/0000-0002-1172-3971</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley |
| subjects | Adult Antiviral agents Antiviral Agents - therapeutic use Carcinoma, Hepatocellular - drug therapy Carcinoma, Hepatocellular - epidemiology Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - virology Female Hepatitis C, Chronic - complications Hepatitis C, Chronic - drug therapy Hepatitis C, Chronic - epidemiology Hepatitis C, Chronic - pathology Hepatocellular carcinoma Humans Interferon Liver cancer Liver Neoplasms - drug therapy Liver Neoplasms - epidemiology Liver Neoplasms - pathology Liver Neoplasms - virology Male Meta-analysis Middle Aged Neoplasm Recurrence, Local - epidemiology Patients Prospective Studies Recurrence Tumors |
| title | Systematic review with meta‐analysis: recurrence of hepatocellular carcinoma following direct‐acting antiviral therapy |
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