Background

Recent studies have identified an increased risk of hepatocellular carcinoma (HCC) in autoimmune hepatitis (AIH). Sex and regional disparities in incidence of HCC in AIH continue to be reported worldwide. Nevertheless, the magnitude of this gap remains unknown.

Method

We searched several databases including PubMed, Embase, Web of Science, Cochrane Library, Wanfang Data, CNKI and SinoMed. Incidence rates of HCC in AIH were combined and analyzed following the EBayes method. Incidence rate ratios were pooled to assess the sex differences. The impact of population difference, sex, age, cirrhotic condition was further analyzed with subgroup analysis and linear regression analysis.

Result

39 studies meeting our eligibility criteria were chosen for the analysis. The pooled incidence rate of HCC in AIH was 3.54 per 1000 person years (95% CI 2.76–4.55). Pooled IRR for the risk of HCC in male AIH patients compared to female was 2.16 (95% CI 1.25–3.75), with mild heterogeneity among studies. The pooled HCC incidence rate in AIH by continents was as follows: Europe 2.37 per 1000 person-years (95% CI 1.45–3.88), Asia 6.18 per 1000 person-years (95%CI 5.51–6.93), North America 2.97 per 1000 person-years (95%CI 2.40–3.68), Oceania 2.60 (95%CI 0.54–7.58). The pooled HCC incidence rate in AIH-related cirrhosis by continent was as follows: Europe 6.35 per 1000 person-years (95%CI 3.94–10.22), Asia 17.02 per 1000 person-years (95%CI 11.18–25.91), North America 10.89 per 1000 person-years (95%CI 6.69–17.74).

Conclusion

A higher HCC incidence in AIH was observed among male and in Asian populations. Cirrhosis status at AIH diagnosis is significantly associated with an increased incidence rate for HCC, and routine HCC surveillance is recommended for patients with AIH cirrhosis, especially for those in Asia.

中文翻译：

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自身免疫性肝炎肝细胞癌发病率的性别和地区差异：系统评价和荟萃分析

背景

最近的研究已经确定自身免疫性肝炎 (AIH) 中肝细胞癌 (HCC) 的风险增加。AIH 中 HCC 发病率的性别和地区差异继续在世界范围内报道。然而，这种差距的大小仍然未知。

方法

我们检索了多个数据库，包括 PubMed、Embase、Web of Science、Cochrane Library、Wanfang Data、CNKI 和 SinoMed。按照 EBayes 方法合并和分析 AIH 中 HCC 的发生率。合并发病率比率以评估性别差异。通过亚组分析和线性回归分析进一步分析人群差异、性别、年龄、肝硬化状况的影响。

结果

选择了 39 项符合我们资格标准的研究进行分析。AIH 中 HCC 的合并发病率为每 1000 人年 3.54（95% CI 2.76-4.55）。与女性相比，男性 AIH 患者发生 HCC 风险的汇总IRR为 2.16（95% CI 1.25-3.75），研究之间存在轻度异质性。各大洲的 AIH 合并 HCC 发病率如下：欧洲 2.37/1000 人年（95% CI 1.45–3.88），亚洲 6.18/1000 人年（95%CI 5.51–6.93），北美 2.97/1000人年 (95%CI 2.40–3.68)，大洋洲 2.60 (95%CI 0.54–7.58)。各大洲 AIH 相关肝硬化的合并 HCC 发病率如下：欧洲 6.35/1000 人年（95%CI 3.94–10.22），亚洲 17.02/1000 人年（95%CI 11.18–25.91），北美每 1000 人年 10.89 (95% CI 6.69–17.74)。

结论

在男性和亚洲人群中观察到 AIH 的 HCC 发病率较高。AIH 诊断时的肝硬化状态与 HCC 发病率增加显着相关，建议对 AIH 肝硬化患者进行常规 HCC 监测，尤其是亚洲患者。