Pei YX, Su CG, Liao Z, Li WW, Wang ZX, Liu JL. Comparative effectiveness of several adjuvant therapies after hepatectomy for hepatocellular carcinoma patients with microvascular invasion. World J Gastrointest Surg 2024; 16(2): 554-570 [PMID: 38463369 DOI: 10.4240/wjgs.v16.i2.554]
Corresponding Author of This Article
Jin-Long Liu, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China. liujl800813@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 554-570 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.554
Comparative effectiveness of several adjuvant therapies after hepatectomy for hepatocellular carcinoma patients with microvascular invasion
Yin-Xuan Pei, Chen-Guang Su, Zheng Liao, Wei-Wei Li, Zi-Xiang Wang, Jin-Long Liu
Yin-Xuan Pei, Chen-Guang Su, Zheng Liao, Wei-Wei Li, Zi-Xiang Wang, Jin-Long Liu, Department of Hepatobiliary Surgery, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Author contributions: Pei YX and Liu JL contributed to the conception and design of the study; Pei YX and Su CG conducted the literature search and extracted the data; Liao Z and Wang ZX assessed methodological quality of included studies; Liao Z was involved in the resolution of all the arguments; Pei YX, Su CG, and Liao Z conducted the data analysis; Pei YX wrote the manuscript; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Long Liu, MD, Chief Doctor, Department of Hepatobiliary Surgery, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China. liujl800813@163.com
Received: October 11, 2023 Peer-review started: October 11, 2023 First decision: December 8, 2023 Revised: December 24, 2023 Accepted: January 18, 2024 Article in press: January 18, 2024 Published online: February 27, 2024
Abstract
BACKGROUND
For resectable hepatocellular carcinoma (HCC), radical hepatectomy is commonly used as a curative treatment. However, postoperative recurrence significantly diminishes the overall survival (OS) of HCC patients, especially with microvascular invasion (MVI) as an independent high-risk factor for recurrence. While some studies suggest that postoperative adjuvant therapy may decrease the risk of recurrence following liver resection in HCC patients, the specific role of adjuvant therapies in those with MVI remains unclear.
AIM
To conduct a network meta-analysis (NMA) to evaluate the efficacy of various adjuvant therapies and determine the optimal adjuvant regimen.
METHODS
A systematic literature search was conducted on PubMed, EMBASE, and Web of Science until April 6, 2023. Studies comparing different adjuvant therapies or comparing adjuvant therapy with hepatectomy alone were included. Hazard ratios (HRs) with 95% confidence intervals were used to combine data on recurrence free survival and OS in both pairwise meta-analyses and NMA.
RESULTS
Fourteen eligible trials (2268 patients) reporting five different therapies were included. In terms of reducing the risk of recurrence, radiotherapy (RT) [HR = 0.34 (0.23, 0.5); surface under the cumulative ranking curve (SUCRA) = 97.7%] was found to be the most effective adjuvant therapy, followed by hepatic artery infusion chemotherapy [HR = 0.52 (0.35, 0.76); SUCRA = 65.1%]. Regarding OS improvement, RT [HR: 0.35 (0.2, 0.61); SUCRA = 93.1%] demonstrated the highest effectiveness, followed by sorafenib [HR = 0.48 (0.32, 0.69); SUCRA = 70.9%].
CONCLUSION
Adjuvant therapy following hepatectomy may reduce the risk of recurrence and provide a survival benefit for HCC patients with MVI. RT appears to be the most effective adjuvant regimen.
Core Tip: This study represents the inaugural network meta-analysis examining the efficacy of postoperative adjuvant therapies in individuals with hepatocellular carcinoma featuring microvascular invasion who underwent curative hepatectomy. Comparing four distinct postoperative adjuvant strategies-transarterial chemoembolization, sorafenib, hepatic artery infusion chemotherapy, and radiotherapy (RT)-we assessed their impact on recurrence free survival and overall survival (OS). The outcomes unveiled that RT emerges as the most effective adjuvant therapy, significantly reducing recurrence risk and extending OS.
