Oncotarget

Research Papers:

Comparing the long-term efficacy of standard and combined minimally invasive procedures for unresectable HCC: a mixed treatment comparison

Jianghai Zhao _, Hui Zhang, Lunshou Wei, Shuping Xie and Zhimin Suo

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Oncotarget. 2017; 8:15101-15113. https://doi.org/10.18632/oncotarget.13145

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Abstract

Jianghai Zhao1,*, Hui Zhang1,*, Lunshou Wei1, Shuping Xie1, Zhimin Suo1

1Department of Gastroenterology, Huaihe Hospital of Henan University, Kaifeng, Henan, 475000, China

*These authors have contributed equally to this work

Correspondence to:

Zhimin Suo, email: [email protected]

Keywords: unresectable hepatocellular carcinoma, transarterial chemoembolization, long-term efficacy, network meta-analysis

Received: May 23, 2016    Accepted: October 12, 2016    Published: November 07, 2016

ABSTRACT

A small proportion of hepatocellular carcinoma (HCC) patients are suitable for surgical resections and various minimally invasive procedures have been introduced as alternatives to surgical resections. However, the relative efficacy of minimally invasive procedures remains to be studied in the current literature. Several popular minimally invasive procedures (monotherapy or combined therapies) were selected for comparison and their relative long-term efficacy were determined by using the statistics of hazard ratio (HR) which evaluates the survival status of HCC patients in one, two, three and four years, respectively. Evidence were obtained from the current literature and synthesized by using the approach of conventional pairwise meta-analysis and network meta-analysis (NMA). Moreover, selected minimally invasive procedures were ranked according to their surface under the cumulative ranking curve (SUCRA) which was produced by NMA in conjunction with the Markov Chain Monte Carlo (MCMC) sampling method. HCC patients treated by combined minimally invasive procedures, particularly transcatheter arterial chemoembolization (TACE) + high intensity focused ultrasound (HIFU), TACE + radiofrequency ablation (RFA), TACE + radiotherapy (RT) and TACE + Sorafenib (SOR) exhibited a significant decrease in the HR compared to those with standard TACE (HR < 1). The combined minimally invasive procedure of TACE + HIFU appears to be the most preferable therapy. PEI seems to be less favorable than other minimally invasive procedures. Combined minimally invasive procedures may be more preferable than standard minimally invasive procedures. Percutaneous ethanol injection (PEI) may not provide adequate efficacy compared to other minimally invasive procedures for unresectable HCC patients.


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