Page 301 - ebook HCC

GENEV
PROGRAMME
EASL HCC SUMMITHCC SUMMIT
298 PROGRAMME AND ABSTRACTSAND ABSTRACTS GENEVA, SWITZERLANDA, SWITZERLAND EASL 299
298
299
FEBRUARY 13 - 16, 2014Y 13 - 16, 2014
FEBRUAR
Poster Board Number C66 Poster Board Number C67
HEPATOCELLULAR CARCINOMA: ANTIVIRAL THERAPY FOR PREVENTION
A RETROSPECTIVE STUDY FROM EASTERN OF HEPATOCELLULAR CARCINOMA AND
PART OF TURKEY MORTALITY IN CHRONIC HEPATITIS B:
SYSTEMATIC REVIEW AND META-ANALYSIS
Ahmet C. Dulger, Müge Tanrıtanır , Kürşat Türkdogan ,
1 2
1
Rafet Mete 1 2 3 , Bilge Gultepe 1 2 3 4
1 Gastroenterology, Yuzuncuyil University Medical School Turkey, Van, Gastroenterology, Maja Thiele , Lise-Lotte Gluud , Emilie K. Dahl , Aleksander Krag 1
2
3
2
1 2
Vakıf Gureba Hospital, İstanbul, Namik Kemal University, Gastroenterology, Tekirdag, 1 Department of Gastroenterology and Hepatology, Odense University Hospital, Odense
3
4 Microbiology, Yuzuncuyil University Medical School Turkey, Van, Turkey
C, Department of Medicine, Copenhagen University Hospital Gentofte, Hellerup,
2
Corresponding author’s e-mail: acdulger@gmail.com 3 Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
Corresponding author’s e-mail: majath@dadlnet.dk
Introduction: Hepatocellular carcinoma (HCC) is one of the commonest liver cancers in
the world as well as in Turkey. Low socioeconomic status is a major risk factor for cirrhosis
as well as HCC. Liver transplantation and liver resection are the main options for long-term
survival in HCC patients fullfilling good prognostic criteria according to recent guidelines. Introduction: The effect of antiviral therapy on clinical outcomes in HBV is not established.
Treatment allocation is based on the BCLC allocation system.
Aims: To assess the effect of antiviral treatment (interferons and/or nucleo(t)side
Aims: Therefore, the aim of this retrospective study was to assess the socioepidemic and
clinic features of the HCC patients. analogues) versus placebo or no intervention on prevention of hepatocellular carcinoma
(HCC) and mortality in chronic hepatitis B (HBV).
Methodology: We completed a retrospective chart review of patients with HCC admitted
to the Yuzuncuyil University Gastroenterology clinic between January 1, 2006 and Methodology: Systematic review with meta-analyses of randomised controlled trials and
December 31, 2012. Diagnosis of HCC was based on non-invasive criteria or pathology. observational studies (prospective cohorts and case control series).
Socioepidemiologic, clinic, and radiologic parameters were recorded on SPSS. One-way
ANOVA tests and chi-square tests were used as statistical analysis.
Results: We included eight RCTs, eight prospective cohort studies and 19 case-control
Results: Seventy-three patients’ data were assessed: 53 male and 20 female; median studies with a total of 3433 patients allocated to antiviral therapy and 4625 controls. The
age 59±14.1 (43-75) years; and the commonest etiology was hepatitis B (71.4%) followed maximum duration of follow up was 23 years. Random effects meta-analysis of RCTs
by delta hepatitis (26.5%). Of these, 76% of patients were resident in rural areas of the found no effect of antiviral therapy on HCC. Cohort studies found that antiviral therapy
prefecture. Child-Turcot-Pugh (CTP) scores of the villagers were significantly higher than
CLINICAL POSTER ABSTRACTS DNA levels were not statistically different between delta hepatitis group and hepatitis B studies found a decreased risk of HCC in the intervention group (risk ratio, 0.69 [CI, 0.54 CLINICAL POSTER ABSTRACTS
increased the risk of HCC (risk ratio, 1.43 [95% CI, 1.06 to 1.95]) whereas case control
patients who were resident in the city center (8.06±2.45 versus 6.71±1.93; p<0.05). HBV-
group (62164±338284 versus 61191±272546, p=0.991). Additionally, male patients were
to 0.88]). There was a clear difference between the results of RCTs and observational
more likely to have elevated ALT levels than female counterparts (79.19±59.02 versus
studies (test for subgroup differences, P < 0.001). Antiviral therapy did not affect mortality
43.90±34.23; p=0.24). Most importantly, distant metastasis among HCC patients with
in RCTs, but reduced mortality in case control studies (overall relative risk, 0.76 [CI 0.63 to
portal vein thrombosis was 54.2% compared to 24.4% in HCC patients with patent portal
0.92]; test for subgroup differences, P = 0.406).
vein (p=0.02). Metastatic patients had also a higher mean tumor diameters (8.88 ±4.64)
and a higher gamma glutamyl transferase (GGT) levels (266.7±228.9) than non-metastatic
patients (5.83±3.71, p=0.004 and 162.7±137.7, p=0.021).
There is clear evidence of bias suggesting that the estimated treatment effects is closely
Conclusion: Living in rural areas was a risk factor for HCC and was associated with an Conclusion: The effect of antiviral therapy on HCC in HBV remains to be established.
increased risk of having higher CTP scores. Delta hepatitis was the second cause of HCC related to the study design. Although there was a positive effect in the sensitivity analyses,
in eastern part of Turkey. Portal vein thrombosis, higher tumor diameters and higher GGT the strength of the evidence does not allow for extrapolation to clinical practice as research
levels migth be a useful tool in predicting metastatic disease in HCC patients. This study design plays an essential role in the overall assessment.
underscores the importance of further examination of this unique patient group in an effort
to endorse the early diagnosis.