Adjuvant chemotherapy for patients with primary hepatocellular carcinoma: A meta-analysis

Numerous studies have investigated the effects of adjuvant chemotherapy for primary hepatocellular carcinoma (HCC) patients. We conducted this analysis to evaluate the efficacy of adjuvant chemotherapy in HCC patients after hepatectomy. PubMed/MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies. The major endpoints were overall survival (OS) and disease-free survival (DFS). The pooled odds ratio (OR) was calculated using a random-effects model to summarize the results. In the meta-analysis of 13 randomized control trials (RCTs) and 35 observational studies with 4747 patients, hepatectomy plus adjuvant chemotherapy showed superiority over hepatectomy alone in 1-year DFS (OR=1.86, 1.38-2.51, p<0.001), 3-year DFS (OR=2.37, 1.73-3.24, p<0.001) and 5-year DFS (OR=1.99, 1.55-2.55, p<0.001), as well as 1-year OS (OR=2.16, 95% confidence interval 1.75-2.68, p<0.001), 3-year OS (OR=1.77, 1.48-2.13, p<0.001) and 5-year OS (OR=1.92, 1.44-2.56, p<0.001). Subgroup and sensitivity analysis revealed that only adjuvant TACE had significant survival benefits. The meta-analysis of studies involving patients with portal vein tumor thrombus (PVTT), but not other factors related to recurrence risk, revealed favorable outcomes of the Treatment arm over the Control arm. The present study shows that adjuvant chemotherapy can improve outcomes for HCC patients. The benefits of adjuvant TACE have been confirmed whereas the effects of other adjuvant chemotherapy modalities remain uncertain. Adjuvant chemotherapy is likely to be more applicable to certain patient populations for instance those with PVTT, but further research in identifying these patient factors is of importance for tailoring adjuvant therapies to individual patients in the future. What's New? There are numerous randomized control trials and observational studies investigating the effects of adjuvant chemotherapy for hepatocellular carcinoma (HCC) patients. The results remain controversial, however. Here, the authors conduct a meta-analysis of all available studies to evaluate the efficacy of adjuvant chemotherapy in patients with primary HCC. They show that adjuvant chemotherapy can improve outcomes for HCC patients. They confirm the benefits of adjuvant transcatheter hepatic arterial chemoembolization (TACE), whereas the effects of other adjuvant chemotherapy modalities remain uncertain. Notably, adjuvant chemotherapy appeared particularly beneficial for patients with portal vein tumor thrombus as a complication of their disease.