Clinical Research Papers:
Optimal adjuvant therapy for resected hepatocellular carcinoma: a systematic review with network meta-analysis
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Gui-Qi Zhu1,2,*, Ke-Qing Shi1,3,*, Hua-Jian Yu1,2, Sun-Yue He1,2, Martin Braddock4, Meng-Tao Zhou5, Yong-Ping Chen1,3, Ming-Hua Zheng1,3
1Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
2School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
3Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
4Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom
5Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
*These authors have contributed equally to this work
Ming-Hua Zheng, e-mail: [email protected]
Meng-Tao Zhou, e-mail: [email protected]
Keywords: hepatocellular carcinoma, adjuvant therapy, toxic effect, network meta-analysis, indirect comparison
Received: March 24, 2015 Accepted: May 26, 2015 Published: June 08, 2015
Objectives: Major adjuvant therapies (ATs) for resected hepatocellular carcinoma (HCC) include chemotherapy, internal radiation therapy (IRT), interferon therapy (IFNT) and immunotherapy but the optimum regimen remains inconclusive. We aim to compare these therapies in terms of patient survival and recurrence rates.
Methods: We searched PubMed, EMBASE and Cochrane library databases for randomized trials comparing the above four therapies until 31 March 2014. We estimated the HRs for survival and ORs for overall recurrence among different therapies. Toxic effects were also evaluated.
Results: Fourteen eligible articles were included. IFNT improved 5-year survival greatly (HR 1.81, 95% CI 1.01–3.81, P = 0.034), whereas chemotherapy (HR 0.33, 95% CI 0.03–2.02), IRT (HR 0.31, 95% CI 0.02–3.33) and immunotherapy (HR 0.73, 95% CI 0.05–9.12) all provided a poorer survival outcome after 1-year. Similarly, for 5-year survival rates, although differing, IRT did not provide a significant improvement in survival (HR 1.38, 95% CI 0.34–5.19) compared with IFNT. Chemotherapy (HR 0.49, 95% CI 0.18–1.14) and immunotherapy (HR 0.56, 95% CI 0.17–1.59) did not appear to provide benefit over IFNT. Chemotherapy was ranked the worst in overall recurrence (OR 0.99, 95% CI 0.18–5.38) and most likely to cause toxic effects.
Conclusions: IFNT was the most efficacious AT regimen both for short and long term survivals. Immunotherapy and IFNT were the most two effective in preventing overall relapse for resected HCC.
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