Low level of hepatitis B viremia is associated with increased risk of hepatocellular carcinoma in compensated cirrhotic patients.

IF 2.5 Q2 GASTROENTEROLOGY & HEPATOLOGY World Journal of Hepatology Pub Date : 2024-11-27 DOI:10.4254/wjh.v16.i11.1321
Wei-Chun Lin, Ke Lin, Ming-Kai Li, Xiao Liu, Yi-Fei Huang, Xing Wang, Bin Wu
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Abstract

Background: Whether patients with compensated cirrhosis and low-level viremia (LLV) of hepatitis B should receive antiviral therapy (AVT) is still controversial, and published results are inconsistent.

Aim: To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma (HCC), decompensation, and liver-related events.

Methods: The PubMed, EMBASE, and Cochrane Library databases were searched up to March 5, 2023. Outcomes of interest were assessed by pooled hazard ratios (HRs). The study was registered with PROSPERO (CRD42023405345).

Results: Six cohort studies representing 3155 patients were included. Compared with patients with undetectable HBV DNA, patients with LLV was associated with increased risk of HCC (HR: 2.06, 95%CI: 1.36-3.13; Q-statistic-P = 0.07, I 2 = 51%) regardless of receiving AVT or not (AVT group: HR: 3.14; 95%CI: 1.73-5.69; Q-statistic-P = 0.60, I 2 = 0%; un-AVT group: HR: 1.73, 95%CI: 1.09-2.76; Q-statistic-P = 0.11, I 2 = 50%). The pooled results showed no statistical association between LLV and decompensation of cirrhosis (HR: 2.06, 95%CI: 0.89-4.76; Q-statistic-P = 0.04, I 2 = 69%), and liver-related events (HR: 1.84, 95%CI: 0.92-3.67; Q-statistic-P = 0.03, I 2 = 72%), respectively. Grading of Recommendations Assessment, Development and Evaluation assessment indicated moderate certainty for HCC, very low certainty for decompensation of cirrhosis and liver-related clinical events.

Conclusion: LLV in compensated cirrhotic patients is associated with increased risk of HCC, higher tendency for hepatic decompensation and liver-related events. Closer screening of HCC should be conducted in this population.

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低水平的乙型肝炎病毒血症与代偿期肝硬化患者罹患肝细胞癌的风险增加有关。
背景:代偿期肝硬化和低水平病毒血症(LLV)患者是否应接受抗病毒治疗仍存在争议,已发表的结果也不一致:目的:研究肝硬化代偿期低水平病毒血症(LLV)与肝细胞癌(HCC)、肝功能失代偿和肝脏相关事件的预后之间的联系:方法:对 PubMed、EMBASE 和 Cochrane Library 数据库进行检索,检索期截至 2023 年 3 月 5 日。相关结果通过汇总危险比(HRs)进行评估。该研究已在 PROSPERO(CRD42023405345)注册:结果:共纳入六项队列研究,代表 3155 名患者。与检测不到 HBV DNA 的患者相比,LLV 患者罹患 HCC 的风险增加(HR:2.06,95%CI:1.36-3.13;Q 统计量-P = 0.07,I 2 = 51%),与是否接受 AVT 无关(AVT 组:HR:3.14;95%CI:1.36-3.13;Q 统计量-P = 0.07,I 2 = 51%):HR:3.14;95%CI:1.73-5.69;Q-statistic-P = 0.60,I 2 = 0%;未接受 AVT 组:HR:1.73,95%CI:1.09-2.76;Q-statistic-P = 0.11,I 2 = 50%)。汇总结果显示,LLV 与肝硬化失代偿(HR:2.06,95%CI:0.89-4.76;Q-statistic-P = 0.04,I 2 = 69%)和肝脏相关事件(HR:1.84,95%CI:0.92-3.67;Q-statistic-P = 0.03,I 2 = 72%)之间分别无统计学关联。推荐评估、发展和评价分级显示,HCC的确定性为中度,肝硬化失代偿和肝脏相关临床事件的确定性为极低:结论:代偿期肝硬化患者的 LLV 与 HCC 风险增加、肝功能失代偿倾向增加和肝脏相关事件增加有关。因此,应对这类人群进行更严密的 HCC 筛查。
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来源期刊
World Journal of Hepatology
World Journal of Hepatology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.10
自引率
4.20%
发文量
172
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