BACKGROUND Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection is highly curative and tolerable. Among patients with hepatocellular carcinoma (HCC), optimal timing of DAA therapy remains unclear. Data on efficacy of DAA therapy in patients with HCC would inform this decision-making. AIM To evaluate response to DAA therapy among patients diagnosed with HCV infection and HCC. METHODS Bibliographic databases and conference abstracts were searched. Meta-analysis was conducted to pool sustained virologic response (SVR) estimates. RESULTS Fifty-six studies with 5522 patients with HCV and HCC were included. Overall SVR was 88.3% (95% CI 86.1-90.4). Twenty-seven studies included patients with prior or present HCC (n = 3126) and patients without HCC (n = 49 138), in which SVR was 88.2% (95% CI 85.0-91.4) and 92.4% (95% CI 91.1-93.7) among patients with and without HCC, respectively (odds ratio: 0.54, 95% CI 0.43-0.68, P < .001). In the subgroup analyses, higher SVR was seen in patients who received curative HCC management (SVR 90.4%, 95% CI 88.3-92.4), or treated with sofosbuvir + NS5A inhibitor DAAs (SVR 96.9%, 95% CI 94.3-99.4), or in patients with HCV genotype 1 infection (SVR 92.0%, 95% CI 88.1-95.6). CONCLUSION Response to DAA therapy was lower in patients with HCC compared to those without HCC, regardless of cirrhosis status. Among HCC patients, there was an impact of proportion with curative HCC management on DAA therapy response.

中文翻译：

---

荟萃分析的系统评价：肝细胞癌患者直接作用抗病毒治疗丙型肝炎的有效性。

背景技术用于丙型肝炎病毒（HCV）感染的直接作用抗病毒（DAA）疗法是高度治愈和可耐受的。在肝细胞癌（HCC）患者中，DAA治疗的最佳时机仍不清楚。有关DAA治疗HCC患者疗效的数据将为这一决策提供依据。目的评估诊断为HCV感染和HCC的患者对DAA治疗的反应。方法检索书目数据库和会议摘要。进行荟萃分析以汇总持续的病毒学应答（SVR）估计值。结果纳入了56项研究，纳入了5522例HCV和HCC患者。总体SVR为88.3％（95％CI 86.1-90.4）。二十七项研究包括既往或目前有HCC的患者（n = 3126）和无HCC的患者（n = 49138），其中SVR分别为88.2％（95％CI 85.0-91.4）和92.4％（95％CI 91.1- 93。7）分别在患有和未患有HCC的患者中（赔率：0.54，95％CI 0.43-0.68，P <.001）。在亚组分析中，接受治愈性HCC治疗（SVR 90.4％，95％CI 88.3-92.4）或接受sofosbuvir + NS5A抑制剂DAA（SVR 96.9％，95％CI 94.3-99.4）的患者中观察到更高的SVR，或患有HCV基因1型感染的患者（SVR为92.0％，95％CI为88.1-95.6）。结论无论肝硬化状态如何，肝癌患者对DAA疗法的反应均低于无肝癌患者。在HCC患者中，治愈性HCC管理比例对DAA治疗反应有影响。或用sofosbuvir + NS5A抑制剂DAA（SVR 96.9％，95％CI 94.3-99.4）进行治疗，或在HCV基因型1感染的患者中（SVR 92.0％，95％CI 88.1-95.6）。结论无论肝硬化状态如何，肝癌患者对DAA疗法的反应均低于无肝癌患者。在HCC患者中，治愈性HCC管理比例对DAA治疗反应有影响。或用sofosbuvir + NS5A抑制剂DAA（SVR 96.9％，95％CI 94.3-99.4）进行治疗，或在HCV基因型1感染的患者中（SVR 92.0％，95％CI 88.1-95.6）。结论无论肝硬化状态如何，肝癌患者对DAA疗法的反应均低于无肝癌患者。在HCC患者中，治愈性HCC管理比例对DAA治疗反应有影响。