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Overview of methodologies and statistical strategies in observational studies and meta-analyses on the risk of hepatocellular carcinoma in patients with chronic hepatitis B on entecavir or tenofovir therapy

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Hepatoma Research 2022年第1期8卷 143-156页

作者： Terry Cheuk-Fung Yip Vincent Wai-Sun Wong Mandy Sze-Man Lai Vicki Wing-Ki Hui yee-kittse Grace Lai-Hung Wong Medical Data Analytics Centre Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina Department of Medicine and Therapeutics 9/F Lui Che Woo Clinical Sciences BuildingPrince of Wales Hospital30-32 Ngan Shing StreetShatinHong KongChina Institute of Digestive Disease The Chinese University of Hong KongHong KongChina

Entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are first-line antiviral therapies for patients with chronic hepatitis B(CHB)and reduce the risk of disease progression and liver-related complications,as well as improve survival by effectively suppressing viral replication.Nevertheless,since the first publication in 2019 on a lower risk of hepatocellular carcinoma(HCC)in Korean patients receiving TDF than those receiving ETV,the topic has remained a hot and unsettled debate.Multiple studies and meta-analyses have yielded conflicting results.As HCC takes time to develop,studies are mainly observational to benefit from a larger sample size and longer follow-up that provides a higher statistical power to compare the two treatments.However,TDF was available to CHB patients a few years later than ETV in most countries,thus leading to a difference in follow-up duration.Moreover,despite studying the same topic,the difference in data sources and available parameters,inclusion and exclusion criteria,and use of statistical methods complicated the interpretation and comparison of the findings and contributed to between-study heterogeneity in meta-analyses.This review describes some caveats in interpreting and comparing the results from these observational studies and meta-analyses.Future studies should explore better designed observational studies with high-quality data sources,and aggregation of patient data in metaanalysis to tackle between-study heterogeneity.

关键词： Bias confounding hepatitis B virus hepatocellular carcinoma liver cancer nucleos(t)ide analogues propensity score

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