ISSN:
1365-2036
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Aim : To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a meta-analysis 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 = 0.002] and 3 years (difference, 27.6%; CI, 8.2–47.1%; P = 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 = 0.005) and 3 years (difference, 28%; CI, 8.2–47.9%; P = 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, post-operative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8–18.3%; P = 0.03), 2 years (difference, 13.5%; CI, 0.9–26%, P = 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 = 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.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1365-2036.2003.01580.x
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