Efficacy evaluation of interventions on recurrent hepatocellular carcinoma after liver transplantation: a network meta-analysis

doi:10.3877/cma.j.issn.1674-3903.2018.04.010

Abstract

Abstract:

Objective

To evaluate and rank the efficacy of seven interventionson on recurrent hepatocellular carcinoma after liver transplantation: surgical resection, retransplantation, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), sorafenib, sorafenib plus TACE and conservative treatment. Hoping to evidence-based medical evidence for clinical treatment.

Methods

Databases including Cochrane library, Embase, PubMed, Web of Science, Wan Fang Data, CNKI, VIP and SinoMed were searched to collect randomized controlled trials, as well as cohort studies about the seven interventions on recurrent hepatocellular carcinoma after liver transplantation from inception to 1 Jan 2018. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then network meta-analysis was performed using Stata 12.0 and WinBUGS 1.4.3 statistical softwares.

Results

A total of 20 retrospective cohort studies was collected in the study, including 604 patients. The 8 articles in the Newcastle-Ottawa scale scored 6 points and 12 in 7 points, all of which were high quality literature. Predicting the efficacy of interventions under the cumulative ranking probability plot. On the 6-month overall survival (OS) rate, the efficacy was ranked: sorafenib+ TACE>RFA>TACE>surgical resection>retransplantation>sorafenib>conservative treatment. On the 1-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>sorafenib>RFA>TACE=retransplantation>conservative treatment. On the 2-year OS rate, the efficacy was ranked: sorafenib+ TACE>surgical resection>RFA>sorafenib>TACE>conservative treatment.

Conclusions

For the treatment of recurrent hepatocellular carcinoma after liver transplantation, the efficacy of sorafenib plus TACE is likely to be the best treatment and the surgical resection and RFA is relatively effective. The efficacy of retransplantation, TACE and sorafenib are relatively poor, conservative treatment may be the worst.

Key words: Primary hepatocellular Carcinoma, Liver transplantation, Recurrence, Network meta-analysis, Efficacy evaluation

Jianbin Cheng, Xuemei Jiang, Peng Liu, Xijie Chen, Xiaoxi Huang. Efficacy evaluation of interventions on recurrent hepatocellular carcinoma after liver transplantation: a network meta-analysis[J]. Chinese Journal of Transplantation(Electronic Edition), 2018, 12(04): 183-187.

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Figures/Tables 6

References 28

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纳入研究	年份	国家	总例数	干预措施	例数	年龄(岁)	男/女(例)	随访(月)	NOS评分(分)
De′Angelis等^[7]	2016	法国	33	索拉非尼	15	M＝58.3	12/3	48	6
?	?	?	?	保守治疗	18	M＝57.3	16/2	?	?
Alsina等^[8]	2014	美国	22	索拉非尼	9	M＝57	8/1	32	7
?	?	?	?	保守治疗	13	M＝57	10/3	?	?
陈建斌等^[9]	2015	中国	27	索拉非尼	12	33～68 (M＝45)	10/2	25	7
?	?	?	?	保守治疗	15	37～66 (M＝48)	13/2	?	?
陈颖华等^[10]	2010	中国	33	RFA	26	31～61 (M＝45)	25/1	18.5	6
?	?	?	?	手术切除	7	27～52 (M＝35)	7/0	?	?
Kim等^[11]	2016	韩国	27	RFA	6	39～61 (M＝50)	5/1	46.4	6
?	?	?	?	TACE	21	44～71 (M＝57.1)	20/1	?	?
Kornberg等^[12]	2010	德国	16	手术切除	7	M＝56.5	6/1	180	7
?	?	?	?	保守治疗	9	M＝56.5	7/2	?	?
李湘竑等^[13]	2011	中国	18	索拉非尼	10	M＝45	9/1	23	6
?	?	?	?	保守治疗	8	M＝45	8/0	?	?
陆雷等^[14]	2012	中国	24	TACE	16	M＝51.3	13/3	60	7
?	?	?	?	TACE＋索拉非尼	8	M＝47.6	7/1	?	?
邱春辉等^[15]	2011	中国	53	手术切除	3	45～54 (M＝NA)	3/0	12	6
?	?	?	?	TACE	22	NA	22/0	?	?
?	?	?	?	RFA	18	NA	18/0	?	?
?	?	?	?	再次肝移植	10	NA	10/0	?	?
Regalia等^[16]	1998	意大利	21	手术切除	7	13～57 (M＝50)	6/1	67	7
?	?	?	?	保守治疗	14	13～57 (M＝50)	12/2	?	?
Sposito等^[17]	2013	意大利	39	索拉非尼	15	17～71 (M＝57)	15/0	58	7
?	?	?	?	保守治疗	24	44～66 (M＝50)	20/4	?	?
汤高枫等^[18]	2013	中国	17	RFA	10	44～60 (M＝50)	10/0	12	6
?	?	?	?	手术切除	7	44～60 (M＝52.3)	7/0	?	?
Taketomi等^[19]	2010	日本	17	手术	9	M＝49.5	7/2	61	7
?	?	?	?	保守治疗	8	M＝45.2	5/3	?	?
Tan等^[20]	2010	中国	20	TACE	10	M＝43.4	10/0	23	6
?	?	?	?	TACE＋索拉非尼	10	M＝46.3	10/0	?	?
吴迪等^[21]	2013	中国	21	再次肝移植	9	36～63 (M＝47.6)	9/0	56	7
Huang等^[22]	2015	中国	78	手术切除	15	NA	9/6	60	7
?	?	?	?	RFA	11	NA	8/3	?	?
?	?	?	?	保守治疗	52	NA	40/12	?	?
Waghray等^[23]	2013	美国	34	索拉非尼	17	M＝57.8	16/1	28	7
?	?	?	?	保守治疗	17	M＝60.2	15/2	?	?
严睿颖等^[24]	2016	中国	29	索拉非尼	14	27～59 (M＝48)	13/1	84	7
?	?	?	?	保守治疗	15	27～59 (M＝48)	14/1	?	?
易小猛等^[25]	2009	中国	47	索拉非尼	23	27～69 (M＝NA)	21/2	14	6
?	?	?	?	保守治疗	24	31～57 (M＝NA)	23/1	?	?
Zhou等^[26]	2010	中国	28	TACE	14	M＝47.3	14/0	14.5	7
?	?	?	?	保守治疗	14	M＝48.5	13/1	?	?

纳入研究	年份	国家	总例数	干预措施	例数	年龄(岁)	男/女(例)	随访(月)	NOS评分(分)
De′Angelis等^[7]	2016	法国	33	索拉非尼	15	M＝58.3	12/3	48	6
?	?	?	?	保守治疗	18	M＝57.3	16/2	?	?
Alsina等^[8]	2014	美国	22	索拉非尼	9	M＝57	8/1	32	7
?	?	?	?	保守治疗	13	M＝57	10/3	?	?
陈建斌等^[9]	2015	中国	27	索拉非尼	12	33～68 (M＝45)	10/2	25	7
?	?	?	?	保守治疗	15	37～66 (M＝48)	13/2	?	?
陈颖华等^[10]	2010	中国	33	RFA	26	31～61 (M＝45)	25/1	18.5	6
?	?	?	?	手术切除	7	27～52 (M＝35)	7/0	?	?
Kim等^[11]	2016	韩国	27	RFA	6	39～61 (M＝50)	5/1	46.4	6
?	?	?	?	TACE	21	44～71 (M＝57.1)	20/1	?	?
Kornberg等^[12]	2010	德国	16	手术切除	7	M＝56.5	6/1	180	7
?	?	?	?	保守治疗	9	M＝56.5	7/2	?	?
李湘竑等^[13]	2011	中国	18	索拉非尼	10	M＝45	9/1	23	6
?	?	?	?	保守治疗	8	M＝45	8/0	?	?
陆雷等^[14]	2012	中国	24	TACE	16	M＝51.3	13/3	60	7
?	?	?	?	TACE＋索拉非尼	8	M＝47.6	7/1	?	?
邱春辉等^[15]	2011	中国	53	手术切除	3	45～54 (M＝NA)	3/0	12	6
?	?	?	?	TACE	22	NA	22/0	?	?
?	?	?	?	RFA	18	NA	18/0	?	?
?	?	?	?	再次肝移植	10	NA	10/0	?	?
Regalia等^[16]	1998	意大利	21	手术切除	7	13～57 (M＝50)	6/1	67	7
?	?	?	?	保守治疗	14	13～57 (M＝50)	12/2	?	?
Sposito等^[17]	2013	意大利	39	索拉非尼	15	17～71 (M＝57)	15/0	58	7
?	?	?	?	保守治疗	24	44～66 (M＝50)	20/4	?	?
汤高枫等^[18]	2013	中国	17	RFA	10	44～60 (M＝50)	10/0	12	6
?	?	?	?	手术切除	7	44～60 (M＝52.3)	7/0	?	?
Taketomi等^[19]	2010	日本	17	手术	9	M＝49.5	7/2	61	7
?	?	?	?	保守治疗	8	M＝45.2	5/3	?	?
Tan等^[20]	2010	中国	20	TACE	10	M＝43.4	10/0	23	6
?	?	?	?	TACE＋索拉非尼	10	M＝46.3	10/0	?	?
吴迪等^[21]	2013	中国	21	再次肝移植	9	36～63 (M＝47.6)	9/0	56	7
Huang等^[22]	2015	中国	78	手术切除	15	NA	9/6	60	7
?	?	?	?	RFA	11	NA	8/3	?	?
?	?	?	?	保守治疗	52	NA	40/12	?	?
Waghray等^[23]	2013	美国	34	索拉非尼	17	M＝57.8	16/1	28	7
?	?	?	?	保守治疗	17	M＝60.2	15/2	?	?
严睿颖等^[24]	2016	中国	29	索拉非尼	14	27～59 (M＝48)	13/1	84	7
?	?	?	?	保守治疗	15	27～59 (M＝48)	14/1	?	?
易小猛等^[25]	2009	中国	47	索拉非尼	23	27～69 (M＝NA)	21/2	14	6
?	?	?	?	保守治疗	24	31～57 (M＝NA)	23/1	?	?
Zhou等^[26]	2010	中国	28	TACE	14	M＝47.3	14/0	14.5	7
?	?	?	?	保守治疗	14	M＝48.5	13/1	?	?

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