Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy

doi:10.4240/wjgs.v15.i2.258

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Feb 27, 2023 (publication date) through Apr 24, 2024

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis

World J Gastrointest Surg. Feb 27, 2023; 15(2): 258-272
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.258

Table 1 Cumulative mean value of 49 arms of studies and patient profiles from 30 articles of curative treatment of recurrent hepatocellular carcinoma after primary liver resection

Arm in study, n	Patient, n¹	Male %	Age in yr	HBV (+) %	HCV (+) %	Cirrhosis %	MVI (+) %	rChild A %	Time to recurrence in mo	rTumor size in mm	rTumor (n = 1) %
RH = 17	1405	79.9	56.5 ± 6.8	68.6	33.3	55.8	29.8	78.7	26.0 ± 8.3	25.3 ± 6.8	76.2
RFA = 11	1013	83.2	56.4 ± 5.5	78.5	12.4	59.0	26.6	94.9	18.1 ± 6.5	21.5 ± 4.0	78.6
TACE = 8	1123	86.5	54.6 ± 8.7	73.4	21.7	49.3	30.7	91.7	14.7 ± 6.6	32.2 ± 16.1	62.3
LT = 12	1484	89.1	53.6 ± 5.3	81.7	9.3	68.4	31.6	76.9	19.4 ± 10.4	27.1 ± 8.0	62.2

¹Patients n, cumulated number of patients in subgroup from all studies.

Details of each study are listed in Supplementary Table 1. RH: Repeated hepatectomy; RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization; LT: Liver transplantation; r: Recurrent; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MVI: Microvascular invasion.

Table 2 Predictive P score for each treatment method for recurrent hepatocellular carcinoma

P score/subgroup	1-yr DFS	3-yr DFS	5-yr DFS	1-yr OS	3-yr OS	5-yr OS
RH	0.6470	0.4999	0.5100	0.7390¹	0.9320¹	0.8331¹
LT	0.9986¹	0.9998¹	0.9820¹	0.6980	0.5470	0.7505
RFA	0.3531	0.0003	0.0080	0.5340	0.5090	0.4159
TACE	0.0012	NA	NA	0.0300	0.0130	0.0500

¹Best treatment option.

DFS: Disease-free survival; NA: Not available; LT: Liver transplantation; OS: Overall survival; RFA: Radio-frequency ablation; RH: Repeated hepatectomy; TACE: Transarterial chemoembolization.

Table 3 Meta-regression analysis for comparison of subgroups

Subgroup	β	SE	95%CI		Z value	P value
Subgroup	β	SE	Lower limit	Upper limit	Z value	P value
1-yr DFS
Intercept	0.658	0.177	0.311	1.005	3.720	< 0.001
LT vs RH	0.930¹	0.283	0.376	1.485	3.290	0.001
RFA vs RH	-0.315	0.272	-0.848	0.217	-1.160	0.246
TACE vs RH	-1.823	0.447	-2.699	-0.946	-4.080	< 0.001
3-yr DFS
Intercept	-0.353	0.212	-0.769	0.063	-1.660	0.096
RFA vs RH	-0.609	0.335	-1.266	0.049	-1.810	0.070
TACE vs RH	-2.235	0.751	-3.707	-0.763	-2.980	0.003
LT vs RH	1.181¹	0.322	0.550	1.812	3.670	< 0.001
5-yr DFS
Intercept	-0.748	0.216	-1.171	-0.325	-3.460	0.001
RFA vs RH	-0.834	0.366	-1.552	-0.116	-2.280	0.023
TACE vs RH	-0.762	0.577	-1.893	0.369	-1.320	0.186
LT vs RH	1.258¹	0.324	0.623	1.893	3.880	< 0.001
1-yr OS
Intercept	2.185	0.208	1.777	2.594	10.480	< 0.001
LT vs RH	-0.036¹	0.332	-0.687	0.614	-0.110	0.913
RFA vs RH	-0.041	0.325	-0.677	0.596	-0.130	0.900
TACE vs RH	-0.614	0.332	-1.264	0.036	-1.850	0.064
3-yr OS
Intercept	0.996	0.162	0.679	1.313	6.150	< 0.001
RFA vs RH	-0.394	0.251	-0.885	0.098	-1.570	0.116
TACE vs RH	-1.114	0.287	-1.676	-0.551	-3.880	< 0.001
LT vs RH	0.040¹	0.265	-0.479	0.558	0.150	0.881
5-yr OS
Intercept	0.204	0.185	-0.158	0.565	1.100	0.270
RFA vs RH	-0.317	0.293	-0.890	0.257	-1.080	0.279
TACE vs RH	-0.917	0.328	-1.559	-0.275	-2.800	0.005
LT vs RH	0.392¹	0.298	-0.192	0.975	1.320	0.188

¹Best treatment option.

DFS: Disease-free survival; LT: Liver transplantation; OS: Overall survival; RFA: Radiofrequency ablation; RH: Repeated hepatectomy; SE: Standard error; TACE: Transarterial chemoembolization.

Table 4 Overall heterogeneity of outcome measured by Q test with random effects model and pooled effect size of each subgroup

Outcome	Heterogeneity				Pooled effect (overall)
Outcome	Q value	df (Q)	P value	I²	Z value	95%CI	P value
1-yr DFS	224.670	30	< 0.001	86.65	0.672	0.625-0.716	P < 0.001
3-yr DFS	583.665	30	< 0.001	94.86	0.414	0.370-0.46	P < 0.001
5-yr DFS	764.476	32	< 0.001	95.81	0.315	0.276-0.357	P < 0.001
1-yr OS	219.820	46	< 0.001	79.07	0.874	0.850-0.895	P < 0.001
3-yr OS	437.662	45	0.002	89.72	0.642	0.642-0.714	P < 0.001
5-yr OS	730.285	48	< 0.001	93.43	0.546	0.497-0.594	P = 0.068

DFS: Disease-free survival; OS: Overall survival.

Table 5 Summary of the better pooled outcome of treatments depended on the analysis method

Test method	1-yr DFS	3-yr DFS	5-yr DFS	1-yr OS	3-yr OS	5-yr OS
Wilcoxon rank sum test	LT	LT	LT	RFA	RH	RH
Forest plot analysis	LT	LT	LT	LT	RH	RH
Wald test	LT	LT	LT	LT	RH	RH
P score	LT	LT	LT	RH	RH	RH
Meta-regression analysis	LT	LT	LT	RH	LT	LT

DFS: Disease-free survival; LT: Liver transplantation; RFA: Radio-frequency ablation; RH: Repeated hepatectomy; OS: Overall survival.

Citation: Chen JL, Chen YS, Ker CG. Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy. World J Gastrointest Surg 2023; 15(2): 258-272
URL: https://www.wjgnet.com/1948-9366/full/v15/i2/258.htm
DOI: https://dx.doi.org/10.4240/wjgs.v15.i2.258