Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, Tyne and Wear, UK; Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK.
Leeds Teaching Hospitals NHS Trust Research and Innovation Department, Leeds, UK.
HPB (Oxford). 2021 Apr;23(4):495-505. doi: 10.1016/j.hpb.2020.10.031. Epub 2020 Dec 11.
Several treatment strategies for early stage hepatocellular cancers (HCC) have been evaluated in randomised controlled trials (RCTs). This network meta-analysis (NMA) aimed to explore the relative effectiveness of these different approaches on their impact on overall (OS) and recurrence-free survival (RFS).
A systematic review was conducted to identify RCT's reported up to 23rd January 2020. Indirect comparisons of all regimens were simultaneously compared using random-effects NMA.
Twenty-eight RCT's, involving 3,618 patients, reporting 13 different treatment strategies for early stage HCC were identified. Median follow-up, reported in 22 studies, ranged from 12-93 months. In this NMA, RFA in combination with iodine-125 was ranked first for both RFS (HR: 0.50, 95% CI: 0.19-1.31) and OS (HR: 0.41, 95% CI: 0.19-0.94). In subgroup with solitary HCC, lack of studies reporting RFS precluded reliable analysis. However, RFA in combination with iodine-125 was associated with markedly better OS (HR: 0.21, 95% CI: 0.05-0.93).
This NMA identified RFA in combination with iodine-125 as a treatment delivering better RFS and OS, in patients with early stage HCC, especially for those with solitary HCC. This technique warrants further evaluation in both Asia and Western regions.
多项随机对照试验（RCT）已评估了早期肝细胞癌（HCC）的多种治疗策略。本网络荟萃分析（NMA）旨在探讨这些不同方法对总生存（OS）和无复发生存（RFS）影响的相对有效性。
系统检索截至 2020 年 1 月 23 日发表的 RCT 研究。采用随机效应 NMA 同时比较所有方案的间接比较。
共纳入 28 项 RCT，涉及 3618 例早期 HCC 患者，报道了 13 种不同的治疗策略。22 项研究报告了中位随访时间，范围为 12-93 个月。在本 NMA 中，RFA 联合碘-125 在 RFS（HR：0.50，95%CI：0.19-1.31）和 OS（HR：0.41，95%CI：0.19-0.94）方面均排名第一。在单发 HCC 亚组中，由于缺乏报告 RFS 的研究，因此无法进行可靠的分析。然而，RFA 联合碘-125 与明显更好的 OS 相关（HR：0.21，95%CI：0.05-0.93）。
本 NMA 确定 RFA 联合碘-125 是一种能为早期 HCC 患者提供更好的 RFS 和 OS 的治疗方法，尤其是对单发 HCC 患者。该技术值得在亚洲和西方地区进一步评估。
