Comparative effectiveness of several adjuvant therapies for patients with hepatocellular carcinoma with high-risk factors for recurrence after hepatectomy: a systematic review and meta-analysis

TL;DR

This study compares the effectiveness of different adjuvant therapies for liver cancer patients at high risk of recurrence after surgery, finding that radiation therapy is the most effective.

Contribution

The study provides the first comprehensive meta-analysis comparing multiple adjuvant therapies for high-risk hepatocellular carcinoma patients post-surgery.

Findings

Radiation therapy (RT) was the most effective in improving disease-free survival (HR = 0.31).

RT also showed the highest effectiveness in improving overall survival (HR = 0.31).

TACE, TKI, and HAIC-FOLFOX were also found to be effective in reducing recurrence.

Abstract

For patients with hepatocellular carcinoma (HCC) who have high-risk recurrence factors following hepatectomy, there is currently no comprehensive meta-analysis examining the effects of various adjuvant therapies post-resection. The comparative effectiveness of these different adjuvant therapies remains unclear. Consequently, we conducted a review of available trials involving postoperative adjuvant therapies in patients with HCC who underwent radical resection and presented with factors associated with a high risk of recurrence.

We collected all studies on postoperative adjuvant therapies in HCC patients with high-risk recurrence factors, concluding on September 7, 2024, from PubMed, Embase and Web of Science. In these studies, overall survival (OS) and disease-free survival (DFS) were compared between groups by calculating the combined hazard ratios (HRs) and 95% confidence intervals (CIs).

Forty-five eligible trials (8,409 patients) reporting five different therapies were included. Our results indicated that postoperative adjuvant therapies such as TACE, TKI, RT, and HAIC-FOLFOX are effective. In terms of improving the DFS, RT (HR = 0.31, 95%CI: 0.18–0.52) was found to be the most effective adjuvant therapy, followed by TKI (HR = 0.48, 95%CI: 0.36–0.63). Regarding OS improvement, RT (HR = 0.31, 95%CI: 0.19–0.50) demonstrated the highest effectiveness, followed by TKI (HR = 0.50, 95%CI: 0.38–0.66).

Adjuvant therapy following hepatectomy decreases the risk of recurrence, and HCC patients with high risks of recurrence may benefit. TACE, TKI, RT and HAIC-FOLFOX are effective methods for reducing recurrence after HCC with high risks of recurrence. RT appears to be the most effective adjuvant regimen.

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