Global Underutilization of Antiviral Therapy and Survival Outcomes in Hepatitis B Virus-Related Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of 78 Studies and 68,243 Patients.
Sahith Kudaravalli, Taotao Yan, Cheng-Hao Tseng et al.
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In 30 seconds
This systematic review and meta-analysis assessed antiviral use and its association with survival and hepatocellular carcinoma (HCC) recurrence in adults with HBV-related HCC. Across 78 studies involving 68,243 patients, the pooled antiviral treatment rate was 53.1%; among studies reporting treatment before HCC diagnosis, 17.2% had received therapy. Treated patients had higher pooled 5-year overall survival than untreated patients (72.1% vs. 46.8%, p < 0.01). Antiviral therapy was not associated with a significant difference in HCC recurrence.
Key findings
- The pooled antiviral treatment rate was 53.1% across 52 studies and 41,345 patients.
- Only 17.2% of patients in studies reporting pre-HCC initiation received antiviral therapy before diagnosis.
- Five-year overall survival was 72.1% in treated patients versus 46.8% in untreated patients (p < 0.01).
- Antiviral therapy was not associated with a significant difference in HCC recurrence rates.
Why it matters
The findings identify low antiviral treatment uptake in HBV-related HCC and an association between treatment and better long-term survival. This is relevant to care discussions and guideline considerations, while the absence of a significant recurrence difference suggests that survival and recurrence outcomes should not be conflated.
What to keep in mind
The evidence comes from a meta-analysis of studies rather than a reported randomised comparison; treatment-survival associations may therefore reflect differences between treated and untreated patients.