Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma.

SUMMARY Aim: To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a metaanalysis of randomized and non-randomized controlled trials. Methods: In a first step, a meta-analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non-randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre-operative transarterial chemotherapy, post-operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy. Results: Only post-operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6‐36.9%; P ¼ 0.002] and 3 years (difference, 27.6%; CI, 8.2‐47.1%; P ¼ 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7‐ 40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2‐47.1%; P ¼ 0.005) and 3 years (difference, 28%; CI, 8.2‐47.9%; P ¼ 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, postoperative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8‐18.3%; P ¼ 0.03), 2 years (difference, 13.5%; CI, 0.9‐ 26%, P ¼ 0.04) and 3 years (difference, 18%; CI, 7‐ 28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7‐33%; P ¼ 0.002), 2 years (difference, 35%; CI, 21.4‐46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7‐ 50.3%; P < 0.001). Conclusion: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.