期刊
DIGESTIVE DISEASES AND SCIENCES
卷 66, 期 7, 页码 2439-2451出版社
SPRINGER
DOI: 10.1007/s10620-020-06498-7
关键词
Epidemiology; Hepatology; Hepatocellular carcinoma; Primary biliary cirrhosis; Risk factor; Natural history; Mortality; Systematic review
资金
- U.S. Department of Veterans Affairs
- Houston Veterans Affairs Health Services Research Center of Innovations [CIN13-413]
The risk factors for hepatocellular carcinoma (HCC) in patients with primary biliary cholangitis (PBC) are not clear, but cirrhosis and male gender are shown to be significant factors in increasing HCC incidence. Further studies are needed to evaluate additional risk factors in this population and support current recommendations for HCC surveillance in PBC patients with cirrhosis.
Background The risk and determinants of HCC in patients with primary biliary cholangitis (PBC) are unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and risk factors associated with HCC risk among patients with PBC. Methods We searched PubMed, EMBASE, MEDLINE, Cochrane databases and reference lists from relevant articles to identify cohort studies that examined incidence of HCC in patients with PBC from inception through November 2019. Results A total of 29 studies including 22,615 patients met the eligibility criteria. The median cohort size was 292 patients followed for an average of 76 months. The pooled incidence rate for patients with PBC was 4.17 per 1000 patient-years (95% CI 3.17-5.47). On subgroup analysis, the incidence of HCC in patients with PBC cirrhosis was 15.7 per 1000 patient-years (95% CI 8.73-28.24). The HCC incidence rate was 9.82 per 1000 person-years (95% CI 5.92-16.28) in men and 3.82 per 1000 person-years (95% CI 2.85-5.11) in women. Conclusions Cirrhosis is the strongest risk factor for HCC in patients with PBC. Male gender was also a risk factor. Our meta-analysis supports current recommendations of HCC surveillance in patients with PBC cirrhosis. Further studies are needed to evaluate risk factors in this population.
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