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Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses

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...

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Autores principales: Thiele, Maja, Gluud, Lise Lotte, Fialla, Annette Dam, Dahl, Emilie Kirstine, Krag, Aleksander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167336/
https://www.ncbi.nlm.nih.gov/pubmed/25225801
http://dx.doi.org/10.1371/journal.pone.0107177
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author Thiele, Maja
Gluud, Lise Lotte
Fialla, Annette Dam
Dahl, Emilie Kirstine
Krag, Aleksander
author_facet Thiele, Maja
Gluud, Lise Lotte
Fialla, Annette Dam
Dahl, Emilie Kirstine
Krag, Aleksander
author_sort Thiele, Maja
collection PubMed
description 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
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spelling pubmed-41673362014-09-22 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 PLoS One Research Article 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 Public Library of Science 2014-09-16 /pmc/articles/PMC4167336/ /pubmed/25225801 http://dx.doi.org/10.1371/journal.pone.0107177 Text en © 2014 Thiele et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Thiele, Maja
Gluud, Lise Lotte
Fialla, Annette Dam
Dahl, Emilie Kirstine
Krag, Aleksander
Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title_full Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title_fullStr Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title_full_unstemmed Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title_short Large Variations in Risk of Hepatocellular Carcinoma and Mortality in Treatment Naïve Hepatitis B Patients: Systematic Review with Meta-Analyses
title_sort large variations in risk of hepatocellular carcinoma and mortality in treatment naïve hepatitis b patients: systematic review with meta-analyses
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167336/
https://www.ncbi.nlm.nih.gov/pubmed/25225801
http://dx.doi.org/10.1371/journal.pone.0107177
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