Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 258-272
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.258
Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy
Jen-Lung Chen, Yaw-Sen Chen, Chen-Guo Ker
Jen-Lung Chen, Chen-Guo Ker, Department of General Surgery, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan
Yaw-Sen Chen, Department of Surgery, School of Medicine, I-Shou University, Kaohsiung 824, Taiwan
Author contributions: Chen JL contributed to the research design, analysis, and manuscript revision; Chen YS contributed to the interpretation and conception; Ker CG contributed to the search and evaluation, analysis, and manuscript preparation.
Supported by the Research Fund from E-Da Hospital, No. EDAHS110012.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist statement, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist statement.
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: Chen-Guo Ker, FACS, MD, PhD, Professor, Department of General Surgery, E-Da Hospital, I-Shou University, Yi-Da Road, Jian-Su Village, Yan-Chio District, Kaohsiung 824, Taiwan. ed112739@edah.org.tw
Received: September 26, 2022
Peer-review started: September 26, 2022
First decision: November 15, 2022
Revised: November 28, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 27, 2023
Processing time: 154 Days and 6.9 Hours
Abstract
BACKGROUND

Recurrent hepatocellular carcinoma (rHCC) is a common outcome after curative treatment. Retreatment for rHCC is recommended, but no guidelines exist.

AIM

To compare curative treatments such as repeated hepatectomy (RH), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and liver transplantation (LT) for patients with rHCC after primary hepatectomy by conducting a network meta-analysis (NMA).

METHODS

From 2011 to 2021, 30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA. The Q test was used to assess heterogeneity among studies, and Egger’s test was used to assess publication bias. The efficacy of rHCC treatment was assessed using disease-free survival (DFS) and overall survival (OS).

RESULTS

From 30 articles, a total of 17, 11, 8, and 12 arms of RH, RFA, TACE, and LT subgroups were collected for analysis. Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup, with an odds ratio (OR) of 0.96 (95%CI: 0.31-2.96). However, the RH subgroup had a better 3-year and 5-year OS compared to the LT, RFA, and TACE subgroups. Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis. LT had a better 1-year OS (OR: 1.04, 95%CI: 0.34-03.20), and LT was inferior to RH in 3-year OS (OR: 10.61, 95%CI: 0.21-1.73) and 5-year OS (OR: 0.95, 95%CI: 0.39-2.34). According to the predictive P score evaluation, the LT subgroup had a better DFS, and RH had the best OS. However, meta-regression analysis revealed that LT had a better DFS (P < 0.001) as well as 3-year OS (P = 0.881) and 5-year OS (P = 0.188). The differences in superiority between DFS and OS were due to the different testing methods used.

CONCLUSION

According to this NMA, RH and LT had better DFS and OS for rHCC than RFA and TACE. However, treatment strategies should be determined by the recurrent tumor characteristics, the patient’s general health status, and the care program at each institution.

Keywords: Hepatocellular carcinoma; Recurrence; Network meta-analysis; Curative treatment; Outcome; Survival rate

Core Tip: Network meta-analysis was used to compare treatments for recurrent hepatocellular carcinoma including repeated hepatectomy, radiofrequency ablation, transarterial chemoembolization, and liver transplantation. Thirty articles published from 2012-2021 were included in the analysis. Disease-free survival and overall survival were compared using forest plot analysis and hierarchic step diagram of subgroups by the Wald test, forest plot analysis, and predictive P score for subgroup analysis. Repeated hepatectomy or liver transplantation had better disease-free survival and overall survival compared to the others based on the testing methods from this network meta-analysis.