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Treatment strategies for early stage hepatocellular carcinoma: a systematic review and network meta-analysis of randomised clinical trials

Lookup NU author(s): Professor Helen ReevesORCiD, Professor Derek Manas, Steven White


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© 2020 International Hepato-Pancreato-Biliary Association Inc. Background: 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). Methods: 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. Results: 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). Conclusion: 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.

Publication metadata

Author(s): Kamarajah SK, Bundred JR, Littler P, Reeves H, Manas DM, White SA

Publication type: Review

Publication status: Published

Journal: HPB

Year: 2021

Volume: 23

Issue: 4

Pages: 495-505

Print publication date: 01/04/2021

Online publication date: 11/12/2020

Acceptance date: 14/10/2020

ISSN (print): 1365-182X

ISSN (electronic): 1477-2574

Publisher: Elsevier B.V.


DOI: 10.1016/j.hpb.2020.10.031