Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2016; 22(10): 3038-3051
Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.3038
Hepatitis B virus and hepatitis C virus play different prognostic roles in intrahepatic cholangiocarcinoma: A meta-analysis
Zheng Wang, Yuan-Yuan Sheng, Qiong-Zhu Dong, Lun-Xiu Qin
Zheng Wang, Qiong-Zhu Dong, Lun-Xiu Qin, Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Yuan-Yuan Sheng, Institute of Biomedical Sciences, Fudan University, Shanghai 200032, China
Author contributions: Wang Z, Sheng YY and Dong QZ contributed equally to this work; Qin LX, Dong QZ and Wang Z conceived and designed the study; Wang Z and Sheng YY performed the research; Wang Z and Sheng YY analyzed the data; Wang Z contributed the analysis tools; Wang Z and Dong QZ wrote the paper; and Qin LX and Dong QZ helped edit the manuscript.
Supported by National Key Projects for Infectious Diseases of China, No. 2012ZX10002-012; National Key Basic Research Program of China, No. 2013CB910500; and NSFC Program of International Cooperation and Exchanges, No. 81120108016.
Conflict-of-interest statement: The authors have declared that no conflicts of interest exist.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lun-Xiu Qin, MD, PhD, Department of Surgery, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China. qin_lx@yahoo.com
Telephone: +86-21-54237965 Fax: +86-21-54237965
Received: March 19, 2015
Peer-review started: March 20, 2015
First decision: June 2, 2015
Revised: June 12, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: March 14, 2016
Processing time: 351 Days and 7.9 Hours
Abstract

AIM: To identify the prognostic value of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in patients with intrahepatic cholangiocarcinoma.

METHODS: A search was performed for relevant publications in PubMed, EMBASE and Web of Science databases. The pooled effects were calculated from the available information to identify the relationship between HBV or HCV infection and the prognosis and clinicopathological features. The χ2 and I2 tests were used to evaluate heterogeneity between studies. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated by a fixed-effects model, if no heterogeneity existed. If there was heterogeneity, a random-effects model was applied.

RESULTS: In total, 14 studies involving 2842 cases were enrolled in this meta-analysis. The patients with HBV infection presented better overall and disease-free survival, and the pooled HRs were significant at 0.76 (95%CI: 0.70-0.83) and 0.78 (95%CI: 0.66-0.94), respectively. Additionally, our study revealed that HCV infection was correlated with shortened overall survival in comparison with the control group (HR = 2.64, 95%CI: 1.77-3.93). We also found that HBV infection occurred more frequently in male patients [odds ratio (OR) = 1.91, 95%CI: 1.06-3.44] and was correlated with higher levels of serum aspartate transaminase (AST) and alpha-fetoprotein (AFP) (OR = 1.93, 95%CI: 1.11-3.35; OR = 3.86, 95%CI: 2.58-5.78) and a lower level of serum carbohydrate antigen 19-9 (CA19-9) (OR = 0.47, 95%CI: 0.34-0.65). Moreover, HBV infection was associated with cirrhosis (OR = 6.44, 95%CI: 4.33-9.56), a higher proportion of capsule formation (OR = 6.04, 95%CI: 3.56-10.26), and a lower rate of lymph node metastasis (OR = 0.39, 95%CI: 0.25-0.58). No significant publication bias was seen in any of the enrolled studies.

CONCLUSION: HBV infection may indicate a favorable prognosis in patients with intrahepatic cholangiocarcinoma, while HCV infection suggests a poor prognosis.

Keywords: Hepatitis B virus; Hepatitis C virus; Clinical features; Intrahepatic cholangiocarcinoma; Prognosis

Core tip: This research is the first comprehensive meta-analysis and systematic review to identify the prognostic significance of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in intrahepatic cholangiocarcinoma. According to this study, HBV infection predicted a favorable prognosis; however, HCV infection was correlated with shortened overall survival. These findings will provide useful information for clinical decision-making in patients with intrahepatic cholangiocarcinoma.