A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma

Giuseppe Cabibbo, Salvatore Petta, Marco Barbàra, Gabriele Missale, Roberto Virdone, Eugenio Caturelli, Fabio Piscaglia, Filomena Morisco, Antonio Colecchia, Fabio Farinati, Edoardo Giannini, Franco Trevisani, Antonio Craxì, Massimo Colombo, Calogero Cammà, ITA.LI.CA study group

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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.

Original languageEnglish
Pages (from-to)1157-1166
Number of pages10
JournalLiver International
Volume37
Issue number8
DOIs
Publication statusPublished - Aug 2017

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Hepacivirus
Meta-Analysis
Hepatocellular Carcinoma
Outcome Assessment (Health Care)
Recurrence
Survival
Therapeutics
Antiviral Agents
Randomized Controlled Trials
Benchmarking
alpha-Fetoproteins
MEDLINE
Serum Albumin
Survival Rate
Regression Analysis
Mortality
Population
Neoplasms

Keywords

  • Journal Article

Cite this

Cabibbo, G., Petta, S., Barbàra, M., Missale, G., Virdone, R., Caturelli, E., ... ITA.LI.CA study group (2017). A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma. Liver International, 37(8), 1157-1166. https://doi.org/10.1111/liv.13357

A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma. / Cabibbo, Giuseppe; Petta, Salvatore; Barbàra, Marco; Missale, Gabriele; Virdone, Roberto; Caturelli, Eugenio; Piscaglia, Fabio; Morisco, Filomena; Colecchia, Antonio; Farinati, Fabio; Giannini, Edoardo; Trevisani, Franco; Craxì, Antonio; Colombo, Massimo; Cammà, Calogero; ITA.LI.CA study group.

In: Liver International, Vol. 37, No. 8, 08.2017, p. 1157-1166.

Research output: Contribution to journalArticle

Cabibbo, G, Petta, S, Barbàra, M, Missale, G, Virdone, R, Caturelli, E, Piscaglia, F, Morisco, F, Colecchia, A, Farinati, F, Giannini, E, Trevisani, F, Craxì, A, Colombo, M, Cammà, C & ITA.LI.CA study group 2017, 'A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma', Liver International, vol. 37, no. 8, pp. 1157-1166. https://doi.org/10.1111/liv.13357
Cabibbo, Giuseppe ; Petta, Salvatore ; Barbàra, Marco ; Missale, Gabriele ; Virdone, Roberto ; Caturelli, Eugenio ; Piscaglia, Fabio ; Morisco, Filomena ; Colecchia, Antonio ; Farinati, Fabio ; Giannini, Edoardo ; Trevisani, Franco ; Craxì, Antonio ; Colombo, Massimo ; Cammà, Calogero ; ITA.LI.CA study group. / A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma. In: Liver International. 2017 ; Vol. 37, No. 8. pp. 1157-1166.
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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.",
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T1 - A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma

AU - Cabibbo, Giuseppe

AU - Petta, Salvatore

AU - Barbàra, Marco

AU - Missale, Gabriele

AU - Virdone, Roberto

AU - Caturelli, Eugenio

AU - Piscaglia, Fabio

AU - Morisco, Filomena

AU - Colecchia, Antonio

AU - Farinati, Fabio

AU - Giannini, Edoardo

AU - Trevisani, Franco

AU - Craxì, Antonio

AU - Colombo, Massimo

AU - Cammà, Calogero

AU - ITA.LI.CA study group

N1 - © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2017/8

Y1 - 2017/8

N2 - 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.

AB - 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.

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DO - 10.1111/liv.13357

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VL - 37

SP - 1157

EP - 1166

JO - Liver International

JF - Liver International

SN - 1478-3223

IS - 8

ER -