Meta-Analysis
Copyright ©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
Processing time: 149 Days and 21.7 Hours
ARTICLE HIGHLIGHTS
Research background

Patients with primary liver cancer face a high recurrence rate, impacting prognosis significantly. Research has demonstrated the effectiveness of postoperative adjuvant external radiation therapy (RT) in preventing liver cancer recurrence after resection. However, the varying effects of different RT techniques on postoperative liver cancer recurrence necessitate further exploration and investigation.

Research motivation

This study aims to uncover and compare the efficacy of different adjuvant external beam RT (EBRT) methods after hepatectomy. Ultimately, the goal is to guide future experimental investigations, clinical practices, and potentially identify new directions for liver cancer treatment.

Research objectives

This study conducted a network meta-analysis to evaluate different adjuvant external RT methods following liver resection, focusing on overall survival (OS) and disease-free survival (DFS) to identify the optimal approach.

Research methods

In adherence to PRISMA guidelines, this study utilized network meta-analyses to collect data from qualified studies published before July 10, 2023, from various reputable databases. Specifically, relevant studies pertaining to postoperative EBRT following liver resection with OS and DFS as primary endpoints were included for analysis. The effects were evaluated using risk ratios and 95% confidential intervals, with data analysis performed via R and STATA software for comprehensive assessment.

Research results

Inclusive of 1265 patients with hepatocellular carcinoma (HCC) post-liver resection, 12 studies formed the basis of this study. The absence of significant heterogeneity in direct paired comparisons, and consistency in inclusion/exclusion criteria, intervention measures, and outcome indicators, corroborated the assumptions of heterogeneity and transitivity. Findings from the analysis of OS indicated that patients who received stereotactic body radiotherapy (SBRT) after resection exhibited longer OS compared to those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). Moreover, the analysis of DFS revealed that patients treated with 3D-CRT after resection had the longest DFS, while those undergoing IMRT post-resection demonstrated longer OS compared to 3D-CRT and longer DFS compared to SBRT.

Research conclusions

When considering RT options after liver cancer resection for HCC patients, IMRT stands out as a preferred choice due to its association with longer OS than 3D-CRT and longer DFS than SBRT.

Research perspectives

The role of RT in liver cancer treatment is currently uncertain, with some practitioners deeming its use rare and insufficiently effective alongside surgical resection. However, basic research shows that RT can influence epigenetic regulation, apoptosis programming, and the tumor immune microenvironment, potentially extending disease-free and OS. Further understanding of RT mechanisms can pave the way for combining it with chemotherapy, targeted therapy, and immunotherapy, offering new directions for clinical practices.