# 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.

## Key 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.