Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2019; 25(27): 3649-3663
Published online Jul 21, 2019. doi: 10.3748/wjg.v25.i27.3649
Immunotherapy with dendritic cells and cytokine-induced killer cells for hepatocellular carcinoma: A meta-analysis
Jing Cao, Fan-Hua Kong, Xi Liu, Xiao-Bo Wang
Jing Cao, Xiao-Bo Wang, Department of Surgery, Technical University of Munich, Munich 80333, Germany
Fan-Hua Kong, Xi Liu, Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Cao J performed the research; Cao J, Kong FH and Liu X analyzed the data; Cao J drafted the paper; Wang XB designed the research and revised the article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
PRISMA 2009 Checklist statement: The manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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/
Corresponding author: Xiao-Bo Wang, MD, Surgeon, Department of Surgery, Technical University of Munich, Arcisstrasse 21, Munich 80333, Germany. xiaobo.wang@tum.de
Telephone: +49-152-37359648
Received: March 18, 2019
Peer-review started: March 18, 2019
First decision: April 11, 2019
Revised: April 18, 2019
Accepted: June 7, 2019
Article in press: June 8, 2019
Published online: July 21, 2019
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) has been revealed as the second most common cause of cancer-related deaths worldwide. The introduction of cell-based immunotherapy, including dendritic cells (DCs) and cytokine-induced killer cells (CIKs), has brought HCC patients an effective benefit. However, the efficacy and necessity of cellular immunotherapy after different interventional therapy remains to be further explored.

AIM

To investigate the efficacy of cellular immunotherapy, involving DCs and CIKs, combined with different conventional treatments of HCC.

METHODS

We performed a literature search on PubMed and Web of Science up to February 15, 2019. Long-term efficacy (overall survival and recurrence) and short-term adverse effects were investigated to assess the effectiveness of immunotherapy with DCs and/or CIKs. Review Manager 5.3 was used to perform the analysis.

RESULTS

A total of 22 studies involving 3756 patients selected by eligibility inclusion criteria were forwarded for meta-analysis. Combined with the conventional clinical treatment, immunotherapy with DCs and/or CIKs was demonstrated to significantly improve overall survival at 6 mo [risk ratio (RR) = 1.07; 95% confidence interval (CI): 1.01-1.13, P = 0.02], 1 year (RR = 1.12; 95%CI: 1.07-1.17, P < 0.00001), 3 years (RR = 1.23; 95%CI: 1.15-1.31, P < 0.00001) and 5 years (RR = 1.26; 95%CI: 1.15-1.37, P < 0.00001). Recurrence rate was significantly reduced by cellular immunotherapy at 6 mo (RR = 0.50; 95%CI: 0.36-0.69, P < 0.0001) and 1 year (RR = 0.82; 95%CI: 0.75-0.89, P < 0.00001). Adverse effect assessment addressed that immunotherapy with DCs and/or CIKs was accepted as a safe, feasible treatment.

CONCLUSION

Combination immunotherapy with DCs, CIKs and DC/CIK with various routine treatments for HCC was evidently suggested to improve patients’ prognosis by increasing overall survival and reducing cancer recurrence.

Keywords: Hepatocellular carcinoma, Immunotherapy, Dendritic cells, Cytokine-induced killer cells

Core tip: Hepatocellular carcinoma has been revealed as the second most common cause of cancer-related deaths worldwide. Though several analyses have supported the effective benefit of cellular immunotherapy when combined with specific hepatocellular carcinoma treatment, the efficacy and necessity of cellular immunotherapy after different interventional therapy remains to be interrogated. Our study suggested that the combination of immunotherapy with dendritic cells, cytokine-induced killer cells and a combination of the two with various routine hepatocellular carcinoma treatments could evidently improve patients’ prognosis by increasing the overall survival and reduce the recurrence of the malignancy.