Efficacy evaluation of interventions on recurrent hepatocellular carcinoma after liver transplantation: a network meta-analysis

Objective To evaluate and rank the efficacy of seven interventionson on recurrent hepatocellular carcinoma after liver transplantation: surgical resection, retransplantation, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), sorafenib, sorafenib plus TACE and conservative treatment. Hoping to evidence-based medical evidence for clinical treatment. Methods Databases including Cochrane library, Embase, PubMed, Web of Science, Wan Fang Data, CNKI, VIP and SinoMed were searched to collect randomized controlled trials, as well as cohort studies about the seven interventions on recurrent hepatocellular carcinoma after liver transplantation from inception to 1 Jan 2018. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then network meta-analysis was performed using Stata 12.0 and WinBUGS 1.4.3 statistical softwares. Results A total of 20 retrospective cohort studies was collected in the study, including 604 patients. The 8 articles in the Newcastle-Ottawa scale scored 6 points and 12 in 7 points, all of which were high quality literature. Predicting the efficacy of interventions under the cumulative ranking probability plot. On the 6-month overall survival (OS) rate, the efficacy was ranked: sorafenib+ TACE>RFA>TACE>surgical resection>retransplantation>sorafenib>conservative treatment. On the 1-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>sorafenib>RFA>TACE=retransplantation>conservative treatment. On the 2-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>RFA>sorafenib>TACE>conservative treatment. Conclusions For the treatment of recurrent hepatocellular carcinoma after liver transplantation, the efficacy of sorafenib plus TACE is likely to be the best treatment and the surgical resection and RFA is relatively effective. The efficacy of retransplantation, TACE and sorafenib are relatively poor, conservative treatment may be the worst. Key words: Primary hepatocellular Carcinoma; Liver transplantation; Recurrence; Network meta-analysis; Efficacy evaluation