■直接作用抗病毒药物(DAA)对慢性丙型肝炎病毒(HCV)治疗有效。然而,它们对总生存期(OS)的影响,肝细胞癌(HCC)发生,无肝癌生存率,HCV失代偿期肝硬化患者的肝功能仍不确定。本研究旨在评估DAA治疗对该人群的影响。
■通过搜索MEDLINE确定研究,Scopus,和中央数据库。从Kaplan-Meier曲线中提取OS和无HCC生存概率和时间数据。使用参数Weibull回归进行了一个阶段的荟萃分析,以估计DAA与DAA的相对治疗效果。没有DAA.主要结果是OS率。次要结果是无肝癌生存率,HCC发生率,和改善终末期肝病模型(MELD)评分。
■八个队列包括3,430名参与者(DAA组2,603名,非DAA组1,999名)。DAA组12个月和24个月的OS概率分别为95%和90%,分别,与无DAA组的89%和80%相比,分别。危险比(HR)为0.48(95%置信区间(CI):0.39,0.60;p<0.001)。12个月和24个月的无HCC生存概率分别为96%和90%,分别,在前者中,94%和85%,分别,在后者中。HCC发生的HR为0.72(95%CI:0.52,1.00;p=0.05),这表明DAA治疗失代偿期肝硬化可能导致HCC发生风险降低28%。平均MELD评分差异为-7.75(95%CI:-14.52,-0.98;p=0.02)。
■OS和MELD评分的改善是DAA治疗HCV失代偿性肝硬化患者的长期益处,治疗对肝癌发展的边缘效应。
UNASSIGNED: Direct-acting antivirals (DAA) are effective for chronic hepatitis C virus (HCV) treatment. However, their impact on overall survival (OS), hepatocellular carcinoma (HCC) occurrence, HCC-free survival, and liver function in patients with HCV decompensated cirrhosis remains uncertain. This study aimed to evaluate the effects of DAA treatment on this population.
UNASSIGNED: Studies were identified by searching the MEDLINE, SCOPUS, and CENTRAL databases. OS and HCC-free survival probabilities and time data were extracted from Kaplan-Meier curves. A one-stage meta-analysis using parametric Weibull regression was conducted to estimate the relative treatment effects of DAA vs. no DAA. The primary outcome was the OS rate. The secondary outcomes were HCC-free survival, HCC occurrence rate, and improvement in the Model for End-stage Liver Disease (MELD) score.
UNASSIGNED: Eight cohorts comprising 3,430 participants (2,603 in the DAA group and 1,999 in the no-DAA group) were included. The OS probabilities at 12 and 24 months were 95 and 90% for the DAA group, respectively, compared with 89 and 80% in the no-DAA group, respectively. Hazard ratio (HR) was 0.48 (95% confidence interval (CI): 0.39, 0.60; p < 0.001). The HCC-free survival probabilities at 12 and 24 months were 96 and 90%, respectively, in the former, and 94 and 85%, respectively, in the latter. The HR of HCC occurrence was 0.72 (95% CI: 0.52, 1.00; p = 0.05), which suggests that DAA treatment in decompensated cirrhosis may lead to a 28% lower risk of HCC occurrence. The mean MELD score difference was -7.75 (95% CI: -14.52, -0.98; p = 0.02).
UNASSIGNED: Improvement in OS and MELD score is a long-term benefit of DAA treatment in patients with HCV decompensated cirrhosis, with a marginal effect of the treatment on HCC development.