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
ARTICLE HIGHLIGHTS
Research 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 remain to be further explored.

Research motivation

Only patients with early to intermediate stage of HCC can benefit from curable interventions. Unfortunately, tumor recurrence within 5 years occurs even with curable treatment. As the introduction of immunotherapy has brought beneficial effects to HCC treatment, better strategies with combined interventions would help to improve the outcomes of HCC patients.

Research objectives

A systematic review and meta-analysis were performed in this study to investigate the efficacy of cellular immunotherapy, involving DCs, CIKs and DC/CIK combination therapy combined with different treatments of HCC.

Research methods

A literature search was performed 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.

Research 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, 1 year, 3 years and 5 years. Recurrence rate was significantly reduced by cellular immunotherapy at 6 mo and 1 year. Adverse effect assessment addressed that immunotherapy with DCs and/or CIKs was accepted as a safe, feasible treatment.

Research conclusions

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.

Research perspectives

This meta-analysis indicated that the combination of conventional therapy and the intervention of immunotherapy with DCs, CIK and DC/CIK could pave the way for a promising approach for HCC treatment. Further assessment of the efficacy of novel immune checkpoint inhibitors based on clinical trials will help us to better identify immunotherapy strategies to treat HCC.