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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 205-214
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.205
Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy
Gao-Yuan Yang, Zhi-Wei He, Yong-Chang Tang, Feng Yuan, Ming-Bo Cao, Yu-Peng Ren, Yu-Xuan Li, Xiao-Rui Su, Zhi-Cheng Yao, Mei-Hai Deng
Gao-Yuan Yang, Zhi-Wei He, Ming-Bo Cao, Yu-Peng Ren, Yu-Xuan Li, Xiao-Rui Su, Mei-Hai Deng, Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Yong-Chang Tang, Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Feng Yuan, Department of General Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, Guangdong Province, China
Zhi-Cheng Yao, Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Co-first authors: Gao-Yuan Yang and Zhi-Wei He.
Co-corresponding authors: Zhi-Cheng Yao and Mei-Hai Deng.
Author contributions: Yao ZC, and Deng MH contributed to the study design, formal analysis, and writing – original draft; Yang GY, He ZW, Tang YC, and Yuan F contributed to the literature research; Ren YP and Li YX contributed to the data acquisition and curation; Yang GY, Cao MB, and Su XR contributed to the writing – review and editing; all authors contributed to the article and approved the submitted version. It is worth noting that Yao ZC and Deng MH made equal contributions to the research design and supervision, so they are listed as the co-corresponding authors. Yang GY and He ZW made equal contributions to the collection, organization and analysis of data and the writing of the manuscript, so they are listed as the co-first authors.
Supported by The Science and Technology Plan Project of Guangzhou, No. 202102010171; National Natural Science Foundation Cultivation Project of The Third Affiliated Hospital of Sun Yat-sen University, No. 2020GZRPYMS11; Natural Science Foundation of Guangdong Province, No. 2018A030313641; and CSCO-Roche Joint Cancer Research Fund, No. Y-Roche2019/2-0041.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Zhi-Cheng Yao, PhD, Doctor, Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. yaozhch2@mail.sysu.edu.cn
Received: August 28, 2023
Peer-review started: August 28, 2023
First decision: November 24, 2023
Revised: December 9, 2023
Accepted: January 9, 2024
Article in press: January 9, 2024
Published online: January 27, 2024
BACKGROUND
Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis. Postoperative adjuvant external radiation therapy (RT) has been shown to effectively prevent recurrence after liver cancer resection. However, there are multiple RT techniques available, and the differential effects of these techniques in preventing postoperative liver cancer recurrence require further investigation.
AIM
To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival (OS) and disease-free survival (DFS) and to determine the optimal strategy.
METHODS
This study involved network meta-analyses and followed the PRISMA guidelines. The data of qualified studies published before July 10, 2023, were collected from PubMed, Embase, the Web of Science, and the Cochrane Library. We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints. The magnitudes of the effects were determined using risk ratios with 95% confidential intervals. The results were analyzed using R software and STATA software.
RESULTS
A total of 12 studies, including 1265 patients with hepatocellular carcinoma (HCC) after liver resection, were included in this study. There was no significant heterogeneity in the direct paired comparisons, and there were no significant differences in the inclusion or exclusion criteria, intervention measures, or outcome indicators, meeting the assumptions of heterogeneity and transitivity. OS analysis revealed that patients who underwent stereotactic body radiotherapy (SBRT) after resection had longer OS than those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS. Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.
CONCLUSION
HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT. IMRT, a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT, may be a preferred option.
Core Tip: The core focus of this study is the comparative analysis of various adjuvant external beam radiation therapy (RT) methods following hepatectomy based on the network meta-analysis. The key aspects emphasized in the study include the efficacy of different RT methods in terms of disease-free survival and overall survival for postoperative liver cancer patients. The research aims to provide valuable insights for future investigations and clinical applications, potentially influencing the direction of liver cancer treatment.
