Impact of Adjuvant Treatment on Liver Cancer Recurrence After Curative Resection

A network meta-analysis published in BMC Gastroenterology evaluated the efficacy and survival outcomes of several adjuvant therapies for hepatocellular carcinoma (HCC) following curative resection. The analysis included data from 32 randomized, controlled trials (RCTs), comprising 5783 patients.

The following treatments were analyzed:

• External radiotherapy
• Branched-chain amino acids
• Internal radiotherapy (IRT)
• Dendritic cell (DC)
• Cytokine-induced killer
• Adoptive immunotherapy
• Huaier
• Interferon
• Oral chemotherapy
• Transarterial chemoembolization (TACE)
• Sorafenib

In addition to studies assessing TACE alone, one study evaluated TACE alone versus TACE plus portal vein chemotherapy (PVC) versus a control group.

Disease Recurrence

According to the authors, 50% of patients with HCC who undergo curative resection might have disease recurrence within 5 years. Previous studies have not found a benefit of adjuvant therapies for preventing disease recurrence. For this meta-analysis, 31 RCTs, including 5629 patients, were utilized for a recurrence analysis.

According to results from the network meta-analysis, TACE plus PVC and TACE plus IRT were found to be beneficial compared with nonadjuvant treatment with regard to prevention of disease recurrence. Odds ratios (ORs) for prevention of recurrence were 2.84 for TACE plus PVC and 2.63 for IRT. SOR was associated with increasing recurrence (OR, 0.57). Other treatments analyzed showed a trend toward preventing recurrence, but results did not differ significantly from nonadjuvant treatment.

Survival Outcomes

A 1-year survival analysis was conducted based on 17 studies, comprising 2047 patients. TACE demonstrated a survival benefit at 1 year (OR, 0.33). A 3-year survival analysis (21 studies, 2463 patients) demonstrated a survival benefit for TACE (OR, 0.51), IRT (OR, 0.41), and DC (OR, 0.09) when compared with nonadjuvant treatment. There were no treatments that demonstrated a 5-year survival benefit, based on data from 16 studies and 1915 patients.

“In conclusion, the effectiveness for different adjuvant treatments in postoperative patients with HCC varies in trials. However, the adjuvant treatments have the trend of preventing recurrence and [increasing] overall survival, although most of the procedures [show] no significant difference when compared [with] nonadjuvant therapy,” the authors wrote.