Chen Jen-Lung, Chen Yaw-Sen, Ker Chen-Guo
Department of General Surgery, E-Da Hospital, I-Shou University, Kaohsiung 824, Taiwan.
Department of Surgery, School of Medicine, I-Shou University, Kaohsiung 824, Taiwan.
World J Gastrointest Surg. 2023 Feb 27;15(2):258-272. doi: 10.4240/wjgs.v15.i2.258.
Recurrent hepatocellular carcinoma (rHCC) is a common outcome after curative treatment. Retreatment for rHCC is recommended, but no guidelines exist.
To compare curative treatments such as repeated hepatectomy (RH), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and liver transplantation (LT) for patients with rHCC after primary hepatectomy by conducting a network meta-analysis (NMA).
From 2011 to 2021, 30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA. The Q test was used to assess heterogeneity among studies, and Egger's test was used to assess publication bias. The efficacy of rHCC treatment was assessed using disease-free survival (DFS) and overall survival (OS).
From 30 articles, a total of 17, 11, 8, and 12 arms of RH, RFA, TACE, and LT subgroups were collected for analysis. Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup, with an odds ratio (OR) of 0.96 (95%CI: 0.31-2.96). However, the RH subgroup had a better 3-year and 5-year OS compared to the LT, RFA, and TACE subgroups. Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis. LT had a better 1-year OS (OR: 1.04, 95%CI: 0.34-03.20), and LT was inferior to RH in 3-year OS (OR: 10.61, 95%CI: 0.21-1.73) and 5-year OS (OR: 0.95, 95%CI: 0.39-2.34). According to the predictive P score evaluation, the LT subgroup had a better DFS, and RH had the best OS. However, meta-regression analysis revealed that LT had a better DFS ( < 0.001) as well as 3-year OS ( = 0.881) and 5-year OS ( = 0.188). The differences in superiority between DFS and OS were due to the different testing methods used.
According to this NMA, RH and LT had better DFS and OS for rHCC than RFA and TACE. However, treatment strategies should be determined by the recurrent tumor characteristics, the patient's general health status, and the care program at each institution.
复发性肝细胞癌（rHCC）是根治性治疗后的常见结局。推荐对rHCC进行再次治疗，但尚无相关指南。
通过进行网状Meta分析（NMA），比较初次肝切除术后rHCC患者的重复肝切除术（RH）、射频消融（RFA）、经动脉化疗栓塞（TACE）和肝移植（LT）等根治性治疗方法。
2011年至2021年，检索了30篇涉及初次肝切除术后rHCC患者的文章用于该NMA。采用Q检验评估研究间的异质性，采用Egger检验评估发表偏倚。使用无病生存期（DFS）和总生存期（OS）评估rHCC治疗的疗效。
从30篇文章中，共收集了RH、RFA、TACE和LT亚组的17、11、8和12个研究臂进行分析。森林图分析显示，LT亚组的累积DFS和1年OS优于RH亚组，优势比（OR）为0.96（95%CI：0.31 - 2.96）。然而，与LT、RFA和TACE亚组相比，RH亚组的3年和5年OS更好。通过Wald检验测量的不同亚组的层次阶梯图得出了与森林图分析相同的结果。LT的1年OS更好（OR：1.04，95%CI：0.34 - 3.20），而LT在3年OS（OR：10.61，95%CI：0.21 - 1.73）和5年OS（OR：0.95，95%CI：0.39 - 2.34）方面不如RH。根据预测P评分评估，LT亚组的DFS更好，而RH的OS最佳。然而，Meta回归分析显示LT的DFS更好（<0.001）以及3年OS（=0.881）和5年OS（=0.188）。DFS和OS优越性的差异是由于使用的测试方法不同。
根据该NMA，对于rHCC，RH和LT的DFS和OS优于RFA和TACE。然而，治疗策略应根据复发性肿瘤特征、患者的一般健康状况以及各机构的护理方案来确定。
