Epidemiology

Eradicating hepatitis C cuts liver cancer risk: meta-analysis

Last Updated: 2013-03-06 15:25:05 -0400 (Reuters Health)

By Megan Brooks

NEW YORK (Reuters Health) - A sustained virologic response (SVR) to treatment for hepatitis C protects against hepatocellular carcinoma (HCC), a new meta-analysis shows.

Among the implications is that "doctors talk about testing with baby boomers and others at risk for hepatitis C, as early detection and referral to care are critical for hepatitis C patients," Rebecca L. Morgan from the Centers for Disease Control and Prevention, who worked on the analysis, told Reuters Health by email.

Her group's findings were "similar among persons at all stages of liver disease and those with advanced liver disease," she said.

The meta-analysis, she explained, was conducted as part of the evidence review in support of the CDC's expanded HCV testing recommendations for baby boomers released in 2012.

The review, published March 5 in Annals of Internal Medicine, specifically examined reduction in the development of HCC with eradication of HCV. "While several previously published meta-analyses have examined the relationship between response to treatment and development of liver cancer, this review is unique because it takes into account adjusted estimates controlling for other known risk factors of liver cancer," Morgan said.

Pooled analysis of 12 studies (involving 25,497 patients) showed that achieving SVR is associated with a significant reduction in risk for HCC for people at all stages of liver disease (relative risk 0.24; p<0.001). Roughly 1.5% of patients responding to treatment developed HCC, compared with 6.2% of patients who did not respond. As a result, the absolute reduction in risk was 4.6% for patients achieving SVR, the authors say.

Pooled data from six studies and two sub-analyses of 2,649 patients with advanced liver disease found that SVR was associated with a similar reduction in risk for HCC (RR 0.23; p<0.001), they note. Overall, 28.5% of patients achieved SVR, and 4.2% of them developed HCC, compared with 17.8% of nonresponders.

Morgan told Reuters Health that based on previously published studies, "we expected a positive association between a viral cure to hepatitis C treatment and development of liver cancer; however, we did not expect a relative risk reduction of over 75% in the development of liver cancer."

Also, she said, "though not unexpected but more clearly delineated in this comprehensive review, we were able to calculate pooled incidence rates of liver cancer development among persons achieving a viral cure or not achieving a viral cure, and determined that there is over a three-fold baseline risk of developing liver cancer among persons who do not achieve a viral cure."

These findings "should be considered when weighing the benefits and harms of identifying and treating HCV-infected patients," the authors of the report conclude.

SOURCE: http://bit.ly/XUDdCj

Ann Intern Med 2013.