scholarly journals Screening for hepatocellular carcinoma in chronic liver disease: a systematic review and meta-analysis of randomized controlled trials comparing screening methodologies

2020 ◽  
Author(s):  
James O'Connell ◽  
Siobhan Rooney
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Liver Disease ◽  
Randomized Controlled Trials ◽  
Chronic Liver Disease ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Screening for hepatocellular carcinoma in chronic liver disease: A systematic review and meta-analysis of randomized controlled trials comparing screening methodologies

2021 ◽  
Author(s):  
James O'Connell
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Randomized Controlled Trials ◽  
Chronic Liver Disease ◽  
Alpha Fetoprotein ◽  
Chronic Liver ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
All Cause Mortality

Abstract BackgroundHepatocellular carcinoma (HCC) is the 5th most prevalent cancer and the second most common cause of cancer-related mortality worldwide. HCC is often asymptomatic until an advanced stage. Current guidelines recommend ultrasound surveillance with or without measurement of serum alpha-fetoprotein. Our objective was to determine if screening for HCC is beneficial or harmful in patients with chronic liver disease. Primary outcomes were all-cause mortality and quality of life. Secondary outcomes were mortality due to HCC, the number of cases of HCC detected and adverse events.MethodsThis is a systematic review and meta-analysis of data from randomized controlled trials. To be included trials had to randomize patients to either an HCC screening group or non-screening group, randomize patients to different screening frequencies or randomize patients to different screening methods. All published reports of randomized trials on screening for HCC were eligible for inclusion, irrespective of the language of publication. Studies had to include patients with chronic liver disease. Data extraction and analysis were performed independently by two reviewers.ResultsWhen screening with six-monthly alpha-fetoprotein and ultrasound abdomen was compared to no screening there was no evidence of difference in HCC related mortality when adjusted for clustering across a range of intracluster correlation coefficients (Intracluster coefficient (ICC) 0.02, odds ratio (OR) 0.60, 95% confidence interval (CI) 0.31-1.15). Screening with six-monthly alpha-fetoprotein when compared to a single alpha-fetoprotein check did not result in a statistically significant difference in all-cause mortality (OR 1.02, 95% confidence interval (CI) 0.65-1.60), mortality due to HCC (OR 1.01, 95% CI 0.57-1.78) or the number of HCC detected (OR 1.11 95% CI 0.64-1.92). There was no evidence of difference in all-cause mortality (OR 0.81, 95% CI 0.26-2.53), mortality due to hepatocellular carcinoma (OR 0.81, 95% CI 0.26-2.53) or the number of patients with HCC detected (OR 1.09 95% CI 0.40-2.99) when twice-a-year ultrasound was compared with annual CT. There was no statistically significant difference when screening more frequently was compared to less frequently in terms of all-cause mortality (OR 0.86, 95% CI 0.56-1.32), mortality due to hepatocellular carcinoma (OR 1.42, 95% CI 0.55-3.64) and the number of cases of hepatocellular carcinoma detected (OR 0.90 95% CI 0.47-1.71).ConclusionsThere is currently insufficient evidence from randomized controlled trials to support the routine screening for HCC in patients with chronic liver disease.

scholarly journals Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2984
Author(s):  
Stepan M. Esagian ◽  
Christos D. Kakos ◽  
Emmanouil Giorgakis ◽  
Lyle Burdine ◽  
J. Camilo Barreto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Transarterial Chemoembolization ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Curative Intent ◽  
Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

Mo1413 IMPACT OF DAILY ASPIRIN THERAPY ON RISK OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CHRONIC LIVER DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1400
Author(s):  
Sakolwan Suchartlikitwong ◽  
Wasawat Vutthikraivit ◽  
Nael Haddad ◽  
Paul A. Muna Aguon ◽  
Faruq Pradhan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Meta Analysis ◽  
Aspirin Therapy ◽  
Chronic Liver ◽  
Daily Aspirin
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