Efficacy and safety of various primary treatment strategies for very early and early hepatocellular carcinoma: a network meta-analysis

Abstract

Background Several treatments are available for treatment of early and very early-stage Hepatocellular Carcinoma, also known as small Hepatocellular Carcinoma (SHCC). However, there is no consensus with regards to the efficacies of these methods. We aimed at identifying the most effective initial treatment strategy for SHCC through Bayesian network meta-analyses. Methods Studies published between January, 2010, and February, 2021 were searched in EMBASE, Cochrane Library, PubMed and Web of science databases, and conference proceedings for trials. The included studies reported the survival outcomes of very early and early Hepatocellular Carcinoma patients subjected to radiofrequency ablation (RFA), microwave ablation (MWA), surgical resection (SR), transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), minimally invasive liver surgery (MIS), stereotactic body radiotherapy (SBRT) and cryoablation (CA). Then, data were extracted from studies that met the inclusion criteria. Patient survival data were retrieved from the published Kaplan–Meier curves and pooled. A Bayesian random-effects model was used to combine direct and indirect evidence. Results A total of 2058 articles were retrieved and screened, from which 45 studies assessing the efficacies of 8 different treatments in 11,364 patients were selected. The included studies had high methodological quality. Recurrence free survival* (progression/recurrence/relapse/disease/tumor-free survival were combined and redefined as RFS*) and overall survival (OS) outcomes were highest in MIS-treated patients (HR 0·57, 95% confidence intervals [CI] 0·38–0·85; HR 0.48,95% CI 0.36–0.64, respectively), followed by SR-treated patients (HR 0.60, 95% CI 0.50–0.74; HR 0.62, 95% CI 0.55–0.72, respectively). TACE was highly efficacious (58.9%) at decreasing the rates of major complications. Similar findings were obtained through sensitivity analysis, and in most of the prognostic subgroups. Conclusions MIS and SR exhibited the highest clinical efficacies, however, they were associated with higher rates of complications. Ablation is effective in small tumors, whereas SBRT is a relatively promising treatment option for SHCC. More well-designed, large-scale randomized controlled trials should be performed to validate our findings.

Transarterial chemoembolization combined with lenvatinib versus transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…Hepatocellular carcinoma (HCC), as the dominant type of liver cancer, accounts for 75-85% of all liver cancer-associated deaths (1,2). Liver surgical resection is still considered as the definitive treatment, with high clinical efficacy for early stage HCC; however, the remaining two-third of patients who do not have early-stage HCC can only receive non-curative treatments (3)(4)(5).…”

Efficacy of Transarterial Chemoembolization (TACE) for Early-Stage Hepatocellular Carcinoma

“…In addition, Yang et al reported the most effective initial treatment strategy for small hepatocellular carcinoma (SHCC) through Bayesian network meta-analyses [21]. In conclusion, TACE was highly efficacious (58.9%) at decreasing the rates of major complications.…”

Parenchymal-sparing anatomical hepatectomy based on portal ramification of the right anterior section: A prospective multicenter experience with short-term outcomes

“…Due to the tumor-bearing portal territory including both the tumor, and the micro-metastases known as satellites, and the mechanism of HCC progression and metastasis being via portal veins, AH showed superior results in overall survivals vs . other local-regional therapies in very early and early HCC [ 3 , 4 ]. Otherwise, recent evidence has confirmed that AH could bring more survival benefits than other types of treatment in selective intermediate and advanced HCC patients [ 5 - 9 ].…”