Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Processing time: 137 Days and 4.5 Hours
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.

Keywords: Hepatocellular carcinoma; Adjuvant therapy; Network meta-analysis; Transarterial chemoembolization; Hepatic artery infusion chemotherapy; Radiotherapy; Sorafenib

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.