Hepatitis C virus (HCV) is a leading cause of hepatocellular carcinoma (HCC). In the
United States, this form of cancer occurs in approximately 15 000 persons annually.
A systematic review of the evidence is needed to assess the benefits of treatment
of HCV-infected persons on development of HCC.
To systematically review observational studies to determine the association between
response to HCV therapy and development of HCC among persons at any stage of fibrosis
and those with advanced liver disease.
MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science, and the Database of
Abstracts of Reviews and Effectiveness from inception through February 2012.
English-language observational studies that compared therapy-derived sustained virologic
response (SVR) with no response to therapy among HCV-infected persons, targeted an
adult population, and had an average follow-up of at least 2 years.
Two investigators independently extracted data into uniform relative risk measures.
The Grading of Recommendations Assessment, Development and Evaluation framework was
used to determine the quality of the evidence.
Thirty studies fulfilled the inclusion criteria, and 18 provided adjusted effect estimates
that were used to calculate pooled relative risks. Among HCV-infected persons, SVR
was associated with reduced risk for HCC (relative risk for all persons, 0.24 [95%
CI, 0.18 to 0.31], moderate-quality evidence; advanced liver disease hazard ratio,
0.23 [CI, 0.16 to 0.35], moderate-quality evidence).
In the meta-analyses, some variables could not be controlled for because of the observational
design of the included studies.
Sustained virologic response after treatment among HCV-infected persons at any stage
of fibrosis is associated with reduced HCC. The evidence was determined to be of moderate
quality.