title: A meta-analysis of single HCV-untreated arm of studies evaluating outcomes after curative treatments of HCV-related hepatocellular carcinoma.
abstract: Determining risk for recurrence or survival after curative resection or ablation in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) is important for stratifying patients according to expected outcomes in future studies of adjuvant therapy in the era of direct-acting antivirals (DAAs). The aims of this meta-analysis were to estimate the recurrence and survival probabilities of HCV-related early HCC following complete response after potentially curative treatment and to identify predictors of recurrence and survival.
  
  
  
  Studies reporting time-dependent outcomes (HCC recurrence or death) after potentially curative treatment of HCV-related early HCC were identified in MEDLINE through May 2016. Data on patient populations and outcomes were extracted from each study by three independent observers and combined using a distribution-free summary survival curve. Primary outcomes were actuarial probabilities of recurrence and survival.
  
  
  
  Eleven studies met the inclusion criteria. Pooled estimates of actuarial recurrence rates were 7.4% at 6 months and 47.0% at 2 years. Pooled estimates of actuarial survival rates were 79.8% at 3 years and 58.6% at 5 years. Heterogeneity among studies was highly significant for all outcomes. By univariate meta-regression analyses, lower serum albumin, randomized controlled trial study design and follow-up were independently associated with higher recurrence risk, whereas tumour size and alpha-foetoprotein levels were associated with higher mortality.
  
  
  
  This meta-analysis showed that recurrence risk and survival are extremely variable in patients with successfully treated HCV-related HCC, providing a useful benchmark for indirect comparisons of the benefits of DAAs and for a correct design of randomized controlled trials in the adjuvant setting.
authors.affiliation: Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy.
authors.forename: Giuseppe
authors.identifier: 0000-0002-2463-1849
authors.initials: G
authors.lastname: Cabibbo
authors.affiliation: Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.affiliation: Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbàra
authors.affiliation: Unit of Infectious Diseases and Hepatology, Teaching Hospital-University of Parma, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Missale
authors.affiliation: Division of Internal Medicine 2, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Virdone
authors.affiliation: Division of Gastroenterology, Belcolle Hospital, Viterbo, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.affiliation: Division of Internal Medicine, Department of Medical and Surgical Sciences, Alma Mater Studiorum, Bologna, Italy.
authors.forename: Fabio
authors.identifier: 0000-0001-8264-1845
authors.initials: F
authors.lastname: Piscaglia
authors.affiliation: Division of Gastroenterology, Department of Medicine and Surgery, University of Naples Federico II, Italy.
authors.forename: Filomena
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino IST, Genoa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Giannini
authors.affiliation: Division of Semeiotics, Department of Medical and Surgical Sciences, Alma Mater Studiorum, Bologna, Italy.
authors.forename: Franco
authors.identifier: 0000-0002-6393-6995
authors.initials: F
authors.lastname: Trevisani
authors.affiliation: Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Humanitas Clinical and Research Center, Rozzano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
authors.affiliation: Section of Gastroenterology, DI.BI.M.I.S., Palermo, Italy.
authors.forename: Calogero
authors.identifier: 0000-0002-9224-1914
authors.initials: C
authors.lastname: Cammà
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy / Q000821:virology; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy / Q000821:virology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*
keywords: hepatocellular carcinoma; prognosis; recurrences; survival