a Department of Ultrasonography , China-Japan Union Hospital of Jilin University , Changchun , Jilin Province , China.
b Department of Nuclear Medicine , China-Japan Union Hospital of Jilin University , Changchun , Jilin Province , China.
Int J Hyperthermia. 2018;35(1):450-462. doi: 10.1080/02656736.2018.1507047. Epub 2018 Oct 25.
It is unclear which kind of interventional therapies is the best when treating early-stage hepatocellular carcinoma (HCC). We conducted Bayesian network meta-analyses to compare local tumor progression (LTP), total tumor recurrence and survival rates and to rank the best intervention arm.
A literature search of Pubmed, Embase, Cochrane library and Clinicaltrials.gov was conducted and randomized controlled trials (RCTs) comparing the outcomes of interventional therapies on early-stage HCC were enrolled. The quality assessment was conducted using Cochrane Collaboration's tool, while the outcome synthesis of the network meta-analysis was conducted using R-3.3.4 software.
A total of 35 RCTs were enrolled for further analysis. Using network meta-analysis, it was demonstrated that radiofrequency ablation (RFA) plus adjuvant therapies achieved the best performance in decreasing the LTP rate in early-stage HCC, while hepatic resection ranked as the best arm among all the interventional techniques for LTP at 3 years. Meanwhile, hepatic resection and RFA plus adjuvant therapies were the top two best arms in decreasing total recurrence. Furthermore, RFA plus adjuvant therapeutics ranked the best in achieving overall survival outcome, followed by hepatic resection. For disease-free survival, hepatic resection was the best, while for LTP-free survival, the difference among the included treatments was not significant.
Our network meta-analysis showed that RFA-based adjuvant therapies might be the most effective interventions in achieving the best outcomes, while hepatic resection exhibited the best performance in several situations in treating early-stage HCC. More RCTs are needed to draw more solid conclusions.
目前尚不清楚治疗早期肝细胞癌（HCC）时哪种介入治疗方法最好。我们进行了贝叶斯网状meta 分析，以比较局部肿瘤进展（LTP）、总肿瘤复发和生存率，并对最佳干预手段进行排名。
对 Pubmed、Embase、Cochrane 图书馆和 Clinicaltrials.gov 进行文献检索，纳入比较早期 HCC 介入治疗结果的随机对照试验（RCT）。使用 Cochrane 协作工具进行质量评估，使用 R-3.3.4 软件进行网状 meta 分析的结果综合。
共纳入 35 项 RCT 进行进一步分析。使用网状 meta 分析表明，射频消融（RFA）加辅助治疗在降低早期 HCC 的 LTP 率方面表现最佳，而肝切除术在所有介入技术中，3 年 LTP 方面表现最佳。同时，肝切除术和 RFA 加辅助治疗是降低总复发率的前两种最佳方法。此外，RFA 加辅助治疗在总体生存结果方面排名最佳，其次是肝切除术。对于无病生存率，肝切除术最佳，而对于 LTP 无生存率，纳入治疗之间的差异无统计学意义。
我们的网状 meta 分析表明，基于 RFA 的辅助治疗可能是实现最佳结果的最有效干预措施，而肝切除术在治疗早期 HCC 的几种情况下表现最佳。需要更多的 RCT 来得出更确凿的结论。
