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Adjuvant therapy options following curative treatment of hepatocellular carcinoma: a systematic review of randomized trials.

AbstractAIMS:
Numerous postoperative therapies for preventing recurrence of hepatocellular carcinoma (HCC) have been reported, but their efficacy remains controversial and knowledge about adverse effects is limited. A systematic review of randomized controlled trials (RCTs) was performed to gain a comprehensive picture of the efficacy and risks of these therapies.
METHODS:
MEDLINE, EMBASE and the Cochrane Library were systematically searched through July 2011. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.
RESULTS:
A total of 2989 patients from 28 RCTs involving 10 postoperative therapies were included. For interferon therapy, the estimated RR for the 2-year recurrence rate was 0.84 (95% CI 0.73-0.97, P = 0.02) and the overall survival (OS) was 1.15 (95% CI 1.07-1.22, P < 0.001). Postoperative therapy with the vitamin K2 analog did not lead to a significant reduction in the 1-year recurrence rate, with a pooled RR of 0.60 (95% CI 0.28-1.27, P = 0.18). However, it did slightly improve the 1-year OS, with a pooled RR of 1.03 (95% CI 1.00-1.05, P = 0.03). Transarterial chemotherapy with or without embolization, adoptive immunotherapy and heparanase inhibitor PI-88 therapy may delay tumor recurrence. The effects of acyclic retinoid, lipiodol-iodine-131 and tumor vaccine treatment were promising but require further study. All postoperative therapies except interferon administered intramuscularly were well tolerated by the majority of patients.
CONCLUSIONS:
Use of adjuvant interferon is definitely associated with an increase in OS. Postoperative therapies involving acyclic retinoid, lipidol-iodine-131, or tumor vaccine may improve the OS of patients with HCC after curative treatment.
AuthorsJ-H Zhong, H Li, L-Q Li, X-M You, Y Zhang, Y-N Zhao, J-Y Liu, B-D Xiang, G-B Wu
JournalEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 38 Issue 4 Pg. 286-95 (Apr 2012) ISSN: 1532-2157 [Electronic] England
PMID22281155 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
Copyright© 2012 Elsevier Ltd. All rights reserved.
Chemical References
  • Adjuvants, Immunologic
  • Antineoplastic Agents
  • Interferons
Topics
  • Adjuvants, Immunologic (administration & dosage)
  • Antineoplastic Agents (administration & dosage)
  • Carcinoma, Hepatocellular (drug therapy, mortality, surgery)
  • Combined Modality Therapy
  • Disease-Free Survival
  • Humans
  • Interferons (administration & dosage)
  • Liver Neoplasms (drug therapy, mortality, surgery)
  • Neoplasm Recurrence, Local (drug therapy, mortality, surgery)
  • Randomized Controlled Trials as Topic
  • Treatment Outcome

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