Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Hepatic Re-resection Versus Transarterial Chemoembolization for the Treatment of Recurrent Hepatocellular Carcinoma after Initial Resection: a Systematic Review and Meta-analysis

  • Wang, Di-Ya (Department of Occupational and Environmental Health Sciences and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University) ;
  • Liu, Lei (Xijing Hospital of Digestive Diseases, Fourth Military Medical University) ;
  • Qi, Xing-Shun (Department of Gastroenterology, General Hospital of Shenyang Military Area) ;
  • Su, Chun-Ping (Library of Fourth Military Medical University) ;
  • Chen, Xue (Department of Gastroenterology, General Hospital of Shenyang Military Area) ;
  • Liu, Xu (Department of Gastroenterology, General Hospital of Shenyang Military Area) ;
  • Chen, Jiang (Department of Gastroenterology, General Hospital of Shenyang Military Area) ;
  • Li, Hong-Yu (Department of Gastroenterology, General Hospital of Shenyang Military Area) ;
  • Guo, Xiao-Zhong (Department of Gastroenterology, General Hospital of Shenyang Military Area)
  • Published : 2015.08.03
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Abstract

Background: A systematic review and meta-analysis were performed to compare the post-recurrence survival with hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC) after initial resection. Materials and Methods: All relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis was performed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studies published in full-text form, and in studies published after 2005. Results: In total, twelve papers were included in our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group than in those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significant and statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with the overall analysis. Conclusions: Hepatic re-resection might provide a better post-recurrence survival than TACE for recurrent HCC after initial resection. However, considering the low quality of published studies and the potential bias of treatment selection, further randomized trials should be warranted to confirm these findings.

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References

  1. (2012). EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 56, 908-43. https://doi.org/10.1016/j.jhep.2011.12.001
  2. Adachi E, Maeda T, Matsumata T, et al (1995). Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology, 108, 768-75. https://doi.org/10.1016/0016-5085(95)90450-6
  3. Balsells J, Charco R, Lazaro JL, et al (1996). Resection of hepatocellular carcinoma in patients with cirrhosis. Br J Surg, 83, 758-61. https://doi.org/10.1002/bjs.1800830610
  4. Belghiti J, Panis Y, Farges O, et al (1991). Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg, 214, 114-7. https://doi.org/10.1097/00000658-199108000-00004
  5. Bruix J, Sherman M (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53, 1020-2. https://doi.org/10.1002/hep.24199
  6. Ercolani G, Grazi GL, Ravaioli M, et al (2003). Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg, 237, 536-43.
  7. Fong Y, Sun RL, Jarnagin W, et al (1999). An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg, 229, 790-9. https://doi.org/10.1097/00000658-199906000-00005
  8. Franco D, Capussotti L, Smadja C, et al (1990). Resection of hepatocellular carcinomas. Results in 72 European patients with cirrhosis. Gastroenterology, 98, 733-8.
  9. Hirokawa F, Hayashi M, Miyamoto Y, et al (2011). Appropriate treatment strategy for intrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma. J Gastrointest Surg, 15, 1182-7. https://doi.org/10.1007/s11605-011-1484-z
  10. Ho CM, Lee PH, Shau WY, et al (2012). Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: comparative effectiveness of treatment modalities. Surgery, 151, 700-9. https://doi.org/10.1016/j.surg.2011.12.015
  11. Hu RH, Ho MC, Wu YM, et al (2005). Feasibility of salvage liver transplantation for patients with recurrent hepatocellular carcinoma. Clin Transplant, 19, 175-80. https://doi.org/10.1111/j.1399-0012.2005.00277.x
  12. Hu Z, Zhou J, Xu X, et al (2012). Salvage liver transplantation is a reasonable option for selected patients who have recurrent hepatocellular carcinoma after liver resection. PLoS One, 7, 36587. https://doi.org/10.1371/journal.pone.0036587
  13. Imaoka S, Sasaki Y, Nakano H, et al (1995). The significance of re-hepatectomy for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma. Acta Hepatologica Japonica, 36, 664-8. https://doi.org/10.2957/kanzo.36.664
  14. Lee PH, Lin WJ, Tsang YM, et al (1995). Clinical management of recurrent hepatocellular carcinoma. Ann Surg, 222, 670-6. https://doi.org/10.1097/00000658-199511000-00010
  15. Liang BY, Huang ZY, Zhou SJ, et al (2014). Primary results of salvage liver transplantation in the patients with unresectable recurrent hepatocellular carcinoma after initial liver resection. Hepatogastroenterology, 61, 2014-20.
  16. Majno PE, Sarasin FP, Mentha G, et al (2000). Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: an outcome-oriented decision analysis. Hepatology, 31, 899-906. https://doi.org/10.1053/he.2000.5763
  17. Minagawa M, Makuuchi M, Takayama T, et al (2003). Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg, 238, 703-10. https://doi.org/10.1097/01.sla.0000094549.11754.e6
  18. Okada S, Shimada K, Yamamoto J, et al (1994). Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology, 106, 1618-24.
  19. Poon RT, Fan ST, Lo CM, et al (2002). Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg, 235, 373-82. https://doi.org/10.1097/00000658-200203000-00009
  20. Poon RT, Fan ST, Lo CM, et al (2001). Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg, 234, 63-70. https://doi.org/10.1097/00000658-200107000-00010
  21. Qi X, Wang D, Su C, et al (2015). Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma: A systematic review and metaanalysis. 2015, In press.
  22. Sala M, Fuster J, Llovet JM, et al (2004). High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transpl, 10, 1294-300. https://doi.org/10.1002/lt.20202
  23. Shimamura T, Une Y, Nakajima Y, et al (1994). [Efficacy of transarterial embolization combined with percutaneous ethanol injection therapy for recurrent hepatocellular carcinoma]. Gan To Kagaku Ryoho, 21, 2229-32.
  24. Shirabe K, Kanematsu T, Matsumata T, et al (1991). Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy: univariate and multivariate analyses. Hepatology, 14, 802-5. https://doi.org/10.1002/hep.1840140510
  25. Takemura N, Hasegawa K, Shindoh J, et al (2014). Significance of therapeutic options for recurrent hcc after liver resection. HPB, 16, 452.
  26. Taniai N, Yoshida H, Mamada Y, et al (2012). What is re-treatment for recurrent patients with hepatocellular carcinoma undergoing hepatectomy? Hepatology International, 6, 241.
  27. Tierney JF, Stewart LA, Ghersi D, et al (2007). Practical methods for incorporating summary time-to-event data into metaanalysis. Trials, 8, 16. https://doi.org/10.1186/1745-6215-8-16
  28. Ueno M, Uchiyama K, Ozawa S, et al (2009). Prognostic impact of treatment modalities on patients with single nodular recurrence of hepatocellular carcinoma. Surg Today, 39, 675-81. https://doi.org/10.1007/s00595-008-3942-0
  29. Umeda Y, Matsuda H, Sadamori H, et al (2011). A prognostic model and treatment strategy for intrahepatic recurrence of hepatocellular carcinoma after curative resection. World J Surg, 35, 170-7. https://doi.org/10.1007/s00268-010-0794-8
  30. Wang K, Liu G, Li J, et al (2014). Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with rehepatectomy, ablation or chemoembolization: A prospective cohort study. Eur J Surg Oncol.
  31. Wu L, Hu A, Tam N, et al (2012). Salvage liver transplantation for patients with recurrent hepatocellular carcinoma after curative resection. PLoS One, 7, 41820. https://doi.org/10.1371/journal.pone.0041820
  32. Yamamoto Y, Ikoma H, Morimura R, et al (2013). Changing trends in long-term outcomes after hepatic resection for hepatocellular carcinoma: A 30-year, single-center experience. Anticancer Res, 33, 5097-105.
  33. Yang LT, Cheng XD, Du YA, et al (2009). [Prognostic factors and outcome in patients with intrahepatic recurrence after hepatectomy for hepatocellular carcinoma]. Zhonghua Zhong Liu Za Zhi, 31, 612-6.

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