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
ARTICLE HIGHLIGHTS
Research background

For resectable hepatocellular carcinoma (HCC), radical hepatectomy is commonly used as a curative treatment. Unfortunately, the 5-year recurrence rate for patients who undergoing hepatectomy ranges from 50% to 70%. 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.

Research motivation

In HCC patient with MVI, various postoperative adjuvant therapies such as transarterial chemoembolization (TACE), hepatic artery infusion chemotherapy (HAIC), sorafenib, and radiotherapy (RT) have been reported. However, the most effective adjuvant therapy among these remains unknown.

Research objectives

The study aimed at assessing the effectiveness of different adjuvant therapies and identifying the most effective adjuvant regimen.

Research 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. Paired meta-analysis and network meta-analysis were conducted to compare the efficacy of various adjuvant therapies. Cumulative probability ranking charts were used to report the probability ranking of different adjuvant therapies. Furthermore, we calculated the surface under the cumulative ranking curve (SUCRA) values to evaluate the interventions that rank the best. In addition, the comparison-adjusted funnel plots and Egger’s tests were used to assess the publication biases.

Research results

Fourteen eligible trials (2268 patients) reporting five different therapies (TACE, HAIC, sorafenib, and RT) were included. In terms of reducing the risk of recurrence, RT was found to be the most effective adjuvant therapy, followed by HAIC. Regarding OS improvement, RT demonstrated the highest effectiveness, followed by sorafenib.

Research conclusions

In summary, 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.

Research perspectives

Future studies should focus on the efficacy and safety of combinations of multiple adjuvant therapies.