scholarly journals Survival benefits from adjuvant transcatheter arterial chemoembolization in patients undergoing liver resection for hepatocellular carcinoma: a systematic review and meta-analysis

2020 ◽  
Vol 13 ◽  
pp. 175628482097769
Author(s):  
Lei Liang ◽  
Chao Li ◽  
Yong-Kang Diao ◽  
Hang-Dong Jia ◽  
Hao Xing ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transcatheter Arterial Chemoembolization ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Free Survival ◽  
Subgroup Analyses ◽  
Disease Free ◽  
Arterial Chemoembolization

Background: Although adjuvant transcatheter arterial chemoembolization (TACE) has been used to prevent recurrence after surgery in patients with hepatocellular carcinoma (HCC), the survival benefits from adjuvant TACE remain controversial. We sought to systematically evaluate the data on the effectiveness of adjuvant TACE for HCC, as well as identify patient populations that might benefit from adjuvant TACE. Methods: The PubMed, Embase, Medline and Cochrane library were systematically searched for studies published before July 2019 that compared adjuvant TACE versus surgery alone for HCC. The study endpoints were overall survival (OS) and disease-free survival (DFS). Patients with large HCC (⩾5 cm), multinodular HCC, microvascular invasion (MVI), or portal vein tumor thrombosis (PVTT) were analyzed in subgroup analyses. Results: Twenty-four studies with 6977 patients were included in the analytic cohort. The pooled analysis demonstrated that adjuvant TACE was associated with a better OS and DFS [hazard ratio (HR): 0.67 and 0.67, both p < 0.01]. In subgroup analyses, pooled results revealed that adjuvant TACE was associated with an improved OS and DFS in patients with multinodular HCC (HR: 0.79 and 0.31, both p < 0.01), MVI (HR: 0.62 and 0.67, both p < 0.01), or PVTT (HR: 0.49 and 0.58, both p < 0.01), but not among patients with large HCC (⩾5 cm). Conclusion: Postoperative adjuvant TACE may be effective to improve OS and DFS in patients with multinodular HCC, or HCC with MVI or PVTT. Future randomized controlled trials are needed to better define the benefit of adjuvant TACE in subset patients with HCC.

scholarly journals Safety of Simultaneous Hepatectomy and Splenectomy in the Treatment of Hepatocellular Carcinoma Complicated with Hypersplenism: A Meta-analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-17
Author(s):  
Xuefeng Liu ◽  
Zhiqiang Chen ◽  
Meng Yu ◽  
Wei Zhou ◽  
Xuting Zhi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Operation Time ◽  
Cochrane Library ◽  
Perioperative Mortality ◽  
Free Survival ◽  
Newcastle Ottawa Scale ◽  
Disease Free ◽  
Ottawa Scale

Background. We conducted this meta-analysis to compare the efficacy and safety of simultaneous hepatectomy and splenectomy (HS) with hepatectomy alone (HA) in patients with hepatocellular carcinoma (HCC) and hypersplenism. Materials and Methods. A systematic search was conducted in PubMed, Embase, Cochrane Library, and Wanfang Data through March 1, 2018, with no limits. Two investigators independently screened all retrieved studies. The investigators of the original publications were contacted if required information was absent. All the included studies were managed by EndNote X7. Quality assessment of the included studies was performed using a modified Newcastle-Ottawa Scale judgment. Extracted data for each endpoint were analyzed by using STATA 12.0 software. Results. Thirteen studies, including a total of 1468 patients, comparing the effects of HS with HA were pooled in this meta-analysis. Outcomes including postoperative complications, perioperative mortality, intraoperative blood transfusion, and albumin (ALB) content at postoperation day (POD) 7 did not differ significantly between the two groups. Simultaneous approaches significantly promoted 1-, 3-, and 5-year disease-free survival (DFS) rates and overall survival (OS) rates, prolonged operation time, aggravated intraoperative blood loss, increased white blood cell (WBC) and platelet (PLT) counts at POD 7, and lowered total bilirubin (T-Bil) contents at POD 1 and 7. Conclusion. Compared to HA, HS is safer and more effective in ameliorating liver function and improving survival of HCC patients complicated with hypersplenism. This trial is registered with CRD42018093779.

scholarly journals Individual or combined transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma: a time-to-event meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chuang Jiang ◽  
Gong Cheng ◽  
Mingheng Liao ◽  
Jiwei Huang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transcatheter Arterial Chemoembolization ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Similar Rate ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Knowledge Infrastructure ◽  
Arterial Chemoembolization

Abstract Background There is still some debate as to whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is better than TACE or RFA alone. This meta-analysis aimed to compare the efficacy and safety of TACE plus RFA for hepatocellular carcinoma (HCC) with RFA or TACE alone. Methods We searched PubMed, MEDLINE, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) for all relevant randomized controlled trials and retrospective studies reporting overall survival (OS), recurrence-free survival (RFS), and complications of TACE plus RFA for HCC, compared with RFA or TACE alone. Results Twenty-one studies involving 3413 patients were included. TACE combined with RFA was associated with better OS (hazard ratio [HR]=0.62, 95% confidence intervals [CI] = 0.55–0.71, P < 0.001) and RFS (HR = 0.52, 95% CI = 0.39–0.69, P < 0.001) than TACE alone; compared with RFA alone, TACE plus RFA resulted in longer OS (HR = 0.63, 95% CI = 0.53–0.75, P < 0.001) and RFS (HR = 0.60, 95% CI = 0.51–0.71, P < 0.001). Subgroup analyses by tumor size also showed that combined treatment resulted in better OS and RFS compared with RFA alone in patients with HCC larger than 3 cm. Combined treatment resulted in similar rate of major complications compared with TACE or RFA alone (OR = 1.78, 95% CI = 0.99–3.20, P = 0.05; OR = 1.00, 95% CI = 0.42–2.38, P = 1.00, respectively). Conclusions TACE combined with RFA was more effective for HCC than TACE alone. For patients with a tumor larger than 3 cm, the combined treatment also achieved a better effect than RFA alone.

scholarly journals Circulatory miRNA as a Biomarker for Therapy Response and Disease-Free Survival in Hepatocellular Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2810
Author(s):  
Muhammad Yogi Pratama ◽  
Alessia Visintin ◽  
Lory Saveria Crocè ◽  
Claudio Tiribelli ◽  
Devis Pascut
Keyword(s):  
Hepatocellular Carcinoma ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Therapy Response ◽  
Circulating Mirnas ◽  
Serum Samples ◽  
Free Survival ◽  
Microarray Profiling ◽  
Disease Free ◽  
Arterial Chemoembolization

The clinical outcome of hepatocellular carcinoma (HCC) treatment remains unsatisfactory, contributing to the high mortality of HCC worldwide. Circulating miRNAs have the potential to be a predictor of therapy response. Microarray profiling was performed in serum samples of 20 HCC patients before treatment. Circulating miRNAs associated with treatment response were validated in 86 serum HCC samples using the qRT-PCR system. Patients were treated either with curative treatments (resection or radiofrequency) or trans-arterial chemoembolization (TACE), and grouped according to therapy response in complete responders (CR) and partial responders or progressive disease (PRPD), following mRECIST criteria. Four miRNA candidates from the discovery phase (miR-4443, miR-4454, miR-4492, and miR-4530) were validated. Before therapy, miR-4454 and miR-4530 were up-regulated in CR to curative treatments (2.83 fold, p = 0.02 and 2.33 fold, p = 0.008, respectively) and were able to differentiate CR from PRPD (area under the curve (AUC) = 0.74, sens/spec 79/63% and AUC = 0.77, sens/spec 72/73%). On the contrary, miR-4443 was 1.95 times down-regulated in CR (p = 0.05) with an AUC of 0.72 (sens = 70%, spec = 60%) in distinguishing CR vs. PRPD. The combination of the three miRNAs was able to predict the response to curative treatment with an AUC of 0.84 (sens = 72%, spec = 75%). The higher levels of miR-4454 and miR-4530 in were associated to longer overall survival (HR = 2.79, p = 0.029 and HR = 2.97, p = 0.011, respectively). Before TACE, miR-4492 was significantly up-regulated in CR patients (FC = 2.67, p = 0.01) and able to differentiate CR from PRPD (AUC = 0.84, sens/spec 84.6/71%). We demonstrated that different miRNAs predictors can be used as potential prognostic circulating biomarkers according to the selected treatment for HCC.

scholarly journals Partial Versus Total Omentectomy in Patients with Gastric Cancer: A Systemic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4971
Author(s):  
Shion Wei Chai ◽  
Suo-Hsien Wang ◽  
Chih-Yuan Wang ◽  
Yi-Chan Chen ◽  
Ruey-Shyang Soong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Systemic Review ◽  
Cochrane Library ◽  
Free Survival ◽  
Significant Difference ◽  
Hospital Stays ◽  
Disease Free

Background: Surgical treatment is the key to cure localized gastric cancer. There is no strong evidence that supports the value of omentectomy. Thus, a meta-analysis was conducted to compare the safety and efficiency of partial and total omentectomy in patients with gastric cancer. Methods: PubMed, Embase, and Cochrane Library databases were searched. All studies that compared total and partial omentectomy as treatments for gastric cancer were included. The primary outcomes were patients’ overall survival and disease-free survival, while the secondary outcomes were perioperative outcome and postoperative complications. Results: A total of nine studies were examined, wherein 1043 patients were included in the partial omentectomy group, and 1995 in the total omentectomy group. The partial omentectomy group was associated with better overall survival (hazard ratio: 0.80, 95% CI: 0.66 to 0.98, p = 0.04, I2 = 0%), shorter operative time, and lesser blood loss than the total omentectomy group. In addition, no statistically significant difference was observed in the number of dissected lymph nodes, length of hospital stays, complication rate, and disease-free survival. Conclusions: Our results show that, compared with total omentectomy in gastric cancer surgery, partial omentectomy had non-inferior oncological outcomes and comparable safety outcomes.

scholarly journals Elevated Preoperative Neutrophil-Lymphocyte Ratio Is Associated with Poor Prognosis in Hepatocellular Carcinoma Patients Treated with Liver Transplantation: A Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Xiao-Dong Sun ◽  
Xiao-Ju Shi ◽  
Yu-Guo Chen ◽  
Chuan-Lei Wang ◽  
Qiang Ma ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Clinical Work ◽  
Free Survival ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Disease Free

This study aims to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) in hepatocellular carcinoma (HCC) patients treated with liver transplantation (LT) through meta-analysis. Relevant articles were sought in PubMed, Embase, and Wangfang databases up to July 2015. A total of 1687 patients from 10 studies were included in this meta-analysis. Meta-analysis results showed that elevated NLR was significantly associated with poorer overall survival (OS) (HR = 2.71, 95% CI: 1.91–3.83) and poorer disease-free survival (DFS) (HR = 3.61, 95% CI: 2.23–5.84) in HCC patients treated with LT. Moreover, subgroup analysis showed the significant association between elevated preoperative NLR and poor prognosis was not altered by cutoff values of NLR or types of LT. Therefore, elevated preoperative NLR is associated with poor prognosis in HCC patients treated with LT. Preoperative NLR should be used to predict the prognosis of HCC after LT in our clinical work.

scholarly journals Prognostic and clinicopathological significance of PD-1 expression in hepatocellular carcinoma: a meta-analysis

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096267
Author(s):  
Qian Zhang ◽  
Kexiang Zhou ◽  
Wei Liang ◽  
Wei Xiong
Keyword(s):  
Hepatocellular Carcinoma ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Tumor Stage ◽  
Alpha Fetoprotein ◽  
Biomedical Literature ◽  
Free Survival ◽  
Programmed Cell Death 1 ◽  
Clinicopathological Significance ◽  
Disease Free

Objective We performed a meta-analysis to evaluate the prognostic and clinicopathological significance of programmed cell death-1 (PD-1) expression in patients with hepatocellular carcinoma (HCC). Methods We searched the Wanfang, Chinese Biomedical Literature, CNKI, PubMed, Embase, and Web of Science databases for relevant articles from inception to 1 July 2020. Statistical analysis was performed using RevMan 5.3 (Cochrane, London, UK) and Stata 14.0 software (StataCorp LP, College Station, TX, USA). Results Eight studies involving 732 patients with HCC were included. Higher expression of PD-1 predicted longer disease-free survival [hazard ratio (HR) 0.53, 95% confidence interval (CI): 0.38–0.72]. No significant correlation was observed between PD-1 expression and overall survival (HR 0.89, 95% CI: 0.58–1.35). PD-1 expression was correlated with age [odds ratio (OR) 0.66, 95% CI: 0.46–0.94] and alpha-fetoprotein level (OR 2.27, 95% CI: 1.45–3.55); no correlation was observed with sex, tumor size, tumor metastasis, hepatitis B virus history, tumor stage, or tumor multiplicity. Sensitivity analysis demonstrated no excessive effect on stability of the pooled results. No significant publication bias was found among the identified studies. Conclusion PD-1 overexpression predicted better disease-free survival in patients with HCC. Moreover, PD-1 expression was associated with age and alpha-fetoprotein level.

scholarly journals Prognostic Influence of Spontaneous Tumor Rupture in Patients with Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

2021 ◽  
Author(s):  
Jiaxuan Xu ◽  
Lihu Gu ◽  
Binbin Xu ◽  
Yuexiu Si ◽  
Yujing He ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Hepatic Resection ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Cochrane Library ◽  
Tumor Rupture ◽  
Free Survival ◽  
Spontaneous Tumor ◽  
Ruptured Hepatocellular Carcinoma

Abstract Background: This study aims to comprehensively analyze the influence of spontaneous tumor rupture on the prognosis of hepatocellular carcinoma patients following hepatic resection.Methods: We systematically searched four online electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, for eligible studies published from inception to March 2021. The main endpoints were overall survival (OS) and disease-free survival (DFS).Results: This meta-analysis included 21 observational articles with 57241 cases. The results revealed that spontaneous tumor rupture was associated with worse OS (hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.33-2.05) and DFS (HR, 1.42; 95% CI, 1.12-1.80) in resectable hepatocellular carcinoma patients. This phenomenon was observed in most subgroups, which were classified by recorded survival time, age, country, alpha-fetoprotein (AFP) concentration, liver cirrhosis, and microvascular invasion. However, in subgroups of macrovascular invasion positive, spontaneous tumor rupture was not a risk factor for OS (HR, 1.55; 95% CI, 0.99-2.42) and DFS (HR, 1.23; 95% CI, 0.91-1.65) in hepatocellular carcinoma patients after hepatectomy. For macrovascular invasion negative, compared with non-ruptured hepatocellular carcinoma patients, ruptured hepatocellular carcinoma patients exhibited worse prognosis for OS (HR, 1.55; 95% CI, 0.99-2.42) and DFS (HR, 1.23; 95% CI, 0.91-1.65) following hepatectomy.Conclusions: Spontaneous tumor rupture was a prognostic risk factor for hepatocellular carcinoma patients after hepatic resection. However, in macrovascular invasion patients, spontaneous tumor rupture was not a prognostic risk factor.

scholarly journals Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5803
Author(s):  
Andrea Grego ◽  
Alberto Friziero ◽  
Simone Serafini ◽  
Amanda Belluzzi ◽  
Lucia Moletta ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Term Survival ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS). Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy. Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.

scholarly journals Comparison of Radiofrequency Ablation with or without Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Xinxin Wang ◽  
Yang Che ◽  
Shiyong Chen ◽  
Biao Wu ◽  
Yu He ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Randomized Controlled Trials ◽  
Tumor Progression ◽  
Transcatheter Arterial Chemoembolization ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Arterial Chemoembolization

Abstract Background To evaluate the curative effect and safety of compare radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC)with the help of a meta-analysis of randomized controlled trials (RCTs) . Materials and Methods RCTs comparing TACE combined with RFA and RFA alone were searched electronically using PubMed, The Cochrane Library, and EMBASE. Fixed and random-effects were used to measure pooled estimates. Research indicators included overall survival (OS), recurrence-free survival (RFA), tumor progression and complications. Results Overall, 6 RCTs were included in this meta-analysis, with a total of 527 patients (TACE-RFA: 271; RFA: 256). 3- and5-year OS rate was higher in the TACE-RFA group than in the RFA group (OR = 1.74; 95% CI: 1.17–2.59; p = 0.006; OR = 2.19; 95% CI: 1.49–3.22; p < 0.0001). The 3- and 5-year RFS rate in the TACE-RFA group was higher than that in the RFA group (OR = 1.92, 95% CI: 1.30 ~ 2.82, p = 0.0009; OR = 1.81, 95% CI: 1.21 ~ 2.70, p = 0.004, respectively). The rate of tumor progression was lower in the TACE-RFA group than in the RFA group (OR = 0.57; 95% CI: 0.38 ~ 0.85; p = 0.005). No significant differences in terms of 1-year OS rate and complications rate were observed between groups.

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