Hepatol Int:乙型肝炎治疗患者肝癌发生风险:替诺福韦低于恩替卡韦

2020-02-28 李敏 临床肝胆病杂志

富马酸替诺福韦(TDF)在降低乙型肝炎患者肝细胞癌发生风险上是否优于恩替卡韦(ETV)目前仍存在争议。本研究拟从临床医学和方法学两方面的角度,通过荟萃分析来探讨这一问题。

富马酸替诺福韦(TDF)在降低乙型肝炎患者肝细胞癌发生风险上是否优于恩替卡韦(ETV)目前仍存在争议。本研究拟从临床医学和方法学两方面的角度,通过荟萃分析来探讨这一问题。

检索PubMed、EMBASE和Cochrane Library数据库,纳入截止到2019年10月28日发表的关于TDF与ETV在降低乙型肝炎患者肝细胞癌发生风险的疗效比较的随机对照试验和队列研究。采用随机效应模型,对根据累积发病率和/或年发病率计算得到的相对危险度比(RR)或风险比(HR)分别进行Meta分析,并通过亚组分析评估各研究间和研究内潜在混杂因素的影响。

本文共纳入32项研究,包括78136例乙型肝炎患者。总体来说,TDF治疗组乙型肝炎患者肝细胞癌的累积发病率显着低于ETV组患者(3.07% vs. 5.25%;RR=0.55; 95%CI,0.42-0.72)。但是,对HR值以及对根据年发病率计算得到的RR值进行meta分析结果显示,并未发现两个治疗组之间存在统计学差异(HR=0.87,95% CI:0.73-1.04;RR=0.88,95%CI:0.67-1.16)。亚组分析结果提示,研究间潜在混杂因素包括既往核苷类似物治疗史、基线时疾病分期和研究开展的地区。需要注意的是,根据纳入文献TDF组和ETV组患者随访时间差异的亚组分析结果显示,随访时间较短的治疗组在降低肝细胞癌发生风险上显得更有效。

与ETV治疗者相比,接受TDF治疗的乙肝患者肝癌累积发病率相对较低。然而,两组患者在随访时间上的差异可能是影响疗效比较结果的关键因素。

在利用大数据进行真实世界疗效比较研究时,除基线混杂因素外,还应关注各组间观察时间的差别对疗效评价的影响。因此,应尽可能采用观察时间相同或相近的数据,并采用合理的统计学方法尽可能控制或减少各种混杂因素不平衡对疗效评价所造成的影响。

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    2020-02-29 gwc384
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    2020-02-28 留走人康

    肝癌,接下来就要细分了,对于体质好的病人,能否将PD-1类+抗血管新生+放疗等相结合,甚至有必要用TACE进行减负

    0

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