Non-selective beta-blockers may reduce risk of hepatocellular carcinoma: a meta-analysis of randomised trials.

BACKGROUND & AIMS:

Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomised trials.

METHODS:

Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I(2) as a measure of heterogeneity. Subgroup, sensitivity, regression, and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing.

RESULTS:

Twenty-three randomised trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC versus 65 of 697 controls (risk difference -0.026; 95% confidence interval -0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I(2) = 7%) or evidence of small-study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC related mortality (RD -0.011; 95% CI -0.040 to 0.017).

CONCLUSIONS:

NSBB may prevent HCC in patients with cirrhosis.. This article is protected by copyright. All rights reserved.