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Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma

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Title: Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma
Authors: Erridge, S
Pucher, PH
Markar, SR
Malietzis, G
Athanasiou, T
Darzi, A
Sodergren, MH
Jiao, LR
Item Type: Journal Article
Abstract: Background Intrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence. Methods A systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival. Results Nineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056). Conclusion Based on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.
Issue Date: 12-Sep-2017
Date of Acceptance: 19-Apr-2017
URI: http://hdl.handle.net/10044/1/53789
DOI: https://dx.doi.org/10.1002/bjs.10597
ISSN: 1365-2168
Publisher: Wiley
Start Page: 1433
End Page: 1442
Journal / Book Title: British Journal of Surgery
Volume: 104
Issue: 11
Copyright Statement: This is the peer reviewed version of the following article: Erridge, S., Pucher, P. H., Markar, S. R., Malietzis, G., Athanasiou, T., Darzi, A., Sodergren, M. H. and Jiao, L. R. (2017), Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma. Br J Surg, 104: 1433–1442, which has been published in final form at https://dx.doi.org/10.1002/bjs.10597.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
2ND HEPATIC RESECTION
RADIOFREQUENCY ABLATION
INTRAHEPATIC RECURRENCE
TRANSARTERIAL CHEMOEMBOLIZATION
TREATMENT MODALITIES
NODULAR RECURRENCE
CURATIVE RESECTION
REPEAT HEPATECTOMY
SURGICAL RESECTION
TREATMENT STRATEGY
Carcinoma, Hepatocellular
Catheter Ablation
Chemoembolization, Therapeutic
Hepatectomy
Humans
Liver Neoplasms
Neoplasm Recurrence, Local
Prognosis
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation