title: Achieving Sustained Virological Response in Hepatitis C Reduces the Long-Term Risk of Hepatocellular Carcinoma: An Updated Meta-Analysis Employing Relative and Absolute Outcome Measures.
abstract: OBJECTIVE
  We studied the effect of achieving sustained virological response (SVR) on the risk of developing hepatocellular carcinoma (HCC) in patients with hepatitis C receiving anti-hepatitis C virus treatment. Avoiding HCC is considered the main long-term benefit of successful antiviral treatment.
  
  
  METHODS
  Our literature search extended up to June 2015. We identified all studies that assessed the risk of HCC in patients achieving or not achieving SVR. Meta-analysis was based on a standard random-effect model. The end-point was occurrence of HCC compared between patients with and without SVR; this end-point was expressed as an odds ratio and percent reduction in risk and was also presented separately for patients with and without cirrhosis. All results estimates presented with 95 % confidence intervals (CIs). The presence of any temporal trend in these indexes was investigated by standard meta-regression.
  
  
  RESULTS
  Our search identified 25 observational studies (19,822 patients). The odds ratio of HCC for SVR versus no-SVR was 0.19 (95 % CI 0.15-0.24) in the overall series of 25 studies. The difference in this index between patients with any stage of fibrosis/cirrhosis and those with cirrhosis was small. With regard to risk difference, the 25 studies indicated an overall reduction of 10 % (95 % CI 8.00-12.0); this effect was much less pronounced in the group with any stage of fibrosis/cirrhosis (risk difference 6.7 %) than in the selected group with cirrhosis (risk difference 22 %). Meta-regression showed no temporal trend.
  
  
  CONCLUSIONS
  Our analysis was successful in providing an updated overview on this controversial topic. Some pharmacoeconomic assessments are also presented to interpret the clinical results of our analysis.
authors.affiliation: HTA Unit, ESTAV Toscana Centro, Regional Health Service, Via San Salvi 12, 50100, Florence, Italy. andrea.messori.it@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Messori
authors.affiliation: HTA Unit, ESTAV Toscana Centro, Regional Health Service, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Badiani
authors.affiliation: HTA Unit, ESTAV Toscana Centro, Regional Health Service, Via San Salvi 12, 50100, Florence, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Trippoli
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D064887:Observational Studies as Topic / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000639:trends; D012254:Ribavirin / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000379:methods / Q000639:trends
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin