Large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis B patients

systematic review with meta-analyses

Maja Thiele, Lise Lotte Gluud, Annette Dam Fialla, Emilie Kirstine Dahl, Aleksander Krag

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: The complications to chronic hepatitis B (HBV) include incidence of hepatocellular carcinoma (HCC) and mortality. The risk of these complications may vary in different patient groups.

AIM: To estimate the incidence and predictors of HCC and in untreated HBV patients.

METHODS: Systematic review with random effects meta-analyses of randomized controlled trials and observational studies. Results are expressed as annual incidence (events per 100 person-years) with 95% confidence intervals. Subgroup and sensitivity analyses of patient and study characteristics were performed to identify common risk factors.

RESULTS: We included 68 trials and studies with a total of 27,584 patients (264,919 person-years). In total, 1,285 of 26,687 (5%) patients developed HCC and 730 of 12,511 (6%) patients died. The annual incidence was 0.88 (95% CI, 0.76-0.99) for HCC and 1.26 (95% CI, 1.01-1.51) for mortality. Patients with cirrhosis had a higher risk of HCC (incidence 3.16; 95% CI, 2.58-3.74) than patients without cirrhosis (0.10; 95% CI, 0.02-0.18). The risk of dying was also higher for patients with than patients without cirrhosis (4.89; 95% CI, 3.16-6.63; and 0.11; 95% CI, 0.09-0.14). The risk of developing HCC increased with HCV coinfection, older age and inflammatory activity. The country of origin did not clearly predict HCC or mortality estimates.

CONCLUSIONS: Cirrhosis was the strongest predictor of HCC incidence and mortality. Patients with HBV cirrhosis have a 31-fold increased risk of HCC and a 44-fold increased mortality compared to non-cirrhotic patients. The low incidence rates should be taken into account when considering HCC screening in non-cirrhotic patients.

TRIAL REGISTRATION: Prospero CRD42013004764.

OriginalsprogEngelsk
Artikelnummere107177
TidsskriftPLOS ONE
Vol/bind9
Udgave nummer9
ISSN1932-6203
DOI
StatusUdgivet - 2014

Fingeraftryk

hepatitis B
systematic review
hepatoma
Hepatitis B
Meta-Analysis
Hepatocellular Carcinoma
incidence
Incidence
Screening
chronic hepatitis B
Chronic Hepatitis B
observational studies
Coinfection
mixed infection
confidence interval
risk factors
Randomized Controlled Trials

Citer dette

@article{f79cc80e6f3f42b080fe06137e99e64d,
title = "Large variations in risk of hepatocellular carcinoma and mortality in treatment na{\"i}ve hepatitis B patients: systematic review with meta-analyses",
abstract = "BACKGROUND: The complications to chronic hepatitis B (HBV) include incidence of hepatocellular carcinoma (HCC) and mortality. The risk of these complications may vary in different patient groups.AIM: To estimate the incidence and predictors of HCC and in untreated HBV patients.METHODS: Systematic review with random effects meta-analyses of randomized controlled trials and observational studies. Results are expressed as annual incidence (events per 100 person-years) with 95{\%} confidence intervals. Subgroup and sensitivity analyses of patient and study characteristics were performed to identify common risk factors.RESULTS: We included 68 trials and studies with a total of 27,584 patients (264,919 person-years). In total, 1,285 of 26,687 (5{\%}) patients developed HCC and 730 of 12,511 (6{\%}) patients died. The annual incidence was 0.88 (95{\%} CI, 0.76-0.99) for HCC and 1.26 (95{\%} CI, 1.01-1.51) for mortality. Patients with cirrhosis had a higher risk of HCC (incidence 3.16; 95{\%} CI, 2.58-3.74) than patients without cirrhosis (0.10; 95{\%} CI, 0.02-0.18). The risk of dying was also higher for patients with than patients without cirrhosis (4.89; 95{\%} CI, 3.16-6.63; and 0.11; 95{\%} CI, 0.09-0.14). The risk of developing HCC increased with HCV coinfection, older age and inflammatory activity. The country of origin did not clearly predict HCC or mortality estimates.CONCLUSIONS: Cirrhosis was the strongest predictor of HCC incidence and mortality. Patients with HBV cirrhosis have a 31-fold increased risk of HCC and a 44-fold increased mortality compared to non-cirrhotic patients. The low incidence rates should be taken into account when considering HCC screening in non-cirrhotic patients.TRIAL REGISTRATION: Prospero CRD42013004764.",
author = "Maja Thiele and Gluud, {Lise Lotte} and Fialla, {Annette Dam} and Dahl, {Emilie Kirstine} and Aleksander Krag",
year = "2014",
doi = "10.1371/journal.pone.0107177",
language = "English",
volume = "9",
journal = "P L o S One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "9",

}

Large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis B patients : systematic review with meta-analyses. / Thiele, Maja; Gluud, Lise Lotte; Fialla, Annette Dam; Dahl, Emilie Kirstine; Krag, Aleksander.

I: PLOS ONE, Bind 9, Nr. 9, e107177, 2014.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis B patients

T2 - systematic review with meta-analyses

AU - Thiele, Maja

AU - Gluud, Lise Lotte

AU - Fialla, Annette Dam

AU - Dahl, Emilie Kirstine

AU - Krag, Aleksander

PY - 2014

Y1 - 2014

N2 - BACKGROUND: The complications to chronic hepatitis B (HBV) include incidence of hepatocellular carcinoma (HCC) and mortality. The risk of these complications may vary in different patient groups.AIM: To estimate the incidence and predictors of HCC and in untreated HBV patients.METHODS: Systematic review with random effects meta-analyses of randomized controlled trials and observational studies. Results are expressed as annual incidence (events per 100 person-years) with 95% confidence intervals. Subgroup and sensitivity analyses of patient and study characteristics were performed to identify common risk factors.RESULTS: We included 68 trials and studies with a total of 27,584 patients (264,919 person-years). In total, 1,285 of 26,687 (5%) patients developed HCC and 730 of 12,511 (6%) patients died. The annual incidence was 0.88 (95% CI, 0.76-0.99) for HCC and 1.26 (95% CI, 1.01-1.51) for mortality. Patients with cirrhosis had a higher risk of HCC (incidence 3.16; 95% CI, 2.58-3.74) than patients without cirrhosis (0.10; 95% CI, 0.02-0.18). The risk of dying was also higher for patients with than patients without cirrhosis (4.89; 95% CI, 3.16-6.63; and 0.11; 95% CI, 0.09-0.14). The risk of developing HCC increased with HCV coinfection, older age and inflammatory activity. The country of origin did not clearly predict HCC or mortality estimates.CONCLUSIONS: Cirrhosis was the strongest predictor of HCC incidence and mortality. Patients with HBV cirrhosis have a 31-fold increased risk of HCC and a 44-fold increased mortality compared to non-cirrhotic patients. The low incidence rates should be taken into account when considering HCC screening in non-cirrhotic patients.TRIAL REGISTRATION: Prospero CRD42013004764.

AB - BACKGROUND: The complications to chronic hepatitis B (HBV) include incidence of hepatocellular carcinoma (HCC) and mortality. The risk of these complications may vary in different patient groups.AIM: To estimate the incidence and predictors of HCC and in untreated HBV patients.METHODS: Systematic review with random effects meta-analyses of randomized controlled trials and observational studies. Results are expressed as annual incidence (events per 100 person-years) with 95% confidence intervals. Subgroup and sensitivity analyses of patient and study characteristics were performed to identify common risk factors.RESULTS: We included 68 trials and studies with a total of 27,584 patients (264,919 person-years). In total, 1,285 of 26,687 (5%) patients developed HCC and 730 of 12,511 (6%) patients died. The annual incidence was 0.88 (95% CI, 0.76-0.99) for HCC and 1.26 (95% CI, 1.01-1.51) for mortality. Patients with cirrhosis had a higher risk of HCC (incidence 3.16; 95% CI, 2.58-3.74) than patients without cirrhosis (0.10; 95% CI, 0.02-0.18). The risk of dying was also higher for patients with than patients without cirrhosis (4.89; 95% CI, 3.16-6.63; and 0.11; 95% CI, 0.09-0.14). The risk of developing HCC increased with HCV coinfection, older age and inflammatory activity. The country of origin did not clearly predict HCC or mortality estimates.CONCLUSIONS: Cirrhosis was the strongest predictor of HCC incidence and mortality. Patients with HBV cirrhosis have a 31-fold increased risk of HCC and a 44-fold increased mortality compared to non-cirrhotic patients. The low incidence rates should be taken into account when considering HCC screening in non-cirrhotic patients.TRIAL REGISTRATION: Prospero CRD42013004764.

U2 - 10.1371/journal.pone.0107177

DO - 10.1371/journal.pone.0107177

M3 - Journal article

VL - 9

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 9

M1 - e107177

ER -