Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):47-57. 10.14701/ahbps.21-080.

Is partial hepatectomy a curable treatment option for hepatocellular carcinoma accompanied by cirrhosis? A meta-analysis and cure model analysis

• Bae B
• Kang K
• Song SK
• Chung CW
• Park Y

• KMID: 2526832
• DOI: http://doi.org/10.14701/ahbps.21-080

Abstract

Backgrounds/Aims
It is challenging to assess the efficacy of partial hepatectomy (PH) as a treatment option for patients with hepatocellular carcinoma (HCC) accompanied by cirrhosis. This study aimed to determine the cure fraction of PH for HCC accompanied by cirrhosis compared to that for HCC without cirrhosis.
Methods
A systematic review was performed on outcomes of previous studies that compared recurrence-free survival (RFS) after PH in patients with HCC with or without cirrhosis. A meta-analysis was conducted to obtain the cumulative hazard ratio for two patient groups: cirrhosis and non-cirrhosis. Cure fractions after PH in both groups were determined using a cure model analysis.
Results
A total of 18 studies were eligible for meta-analysis and 13 studies were selected for the cure model analysis. The cumulative hazard ratio for RFS of the cirrhosis group compared to that of the non-cirrhosis group was 1.66 (95% confidence interval [CI], 1.43–1.93). Survival data of 3,512 patients in both groups were reconstructed from survival curves of original articles for cure model analysis. The probability of being statistically cured after PH for HCC was 14.1% (95% CI, 10.6%–18.1%) in the cirrhosis group lower than that (32.5%) in the non-cirrhosis group (95% CI, 28.6%–36.4%).
Conclusions
The prognosis after PH for HCC accompanied by cirrhosis is inferior to that for HCC without cirrhosis. However, a cure can be expected for one-seventh of patients with HCC accompanied by cirrhosis after PH.

Keyword

Cure fraction; Hepatectomy; Kaplan–Meier estimate; Non-mixture

Figure

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  Fig. 1 Flow chart showing study selection. DFS, disease-free survival.

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  Fig. 2 Forest plot depicting hazard ratio (HR) of recurrence-free survival after partial hepatectomy in patients with hepatocellular carcinoma (HCC) accompanied by cirrhosis compared to that in patients with HCC without cirrhosis using fixed-effect and random-effect models. TE, estimated treatment effect; seTE, standard error of treatment estimate; CI, confidence interval.

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  Fig. 3 Funnel plot of studies included in this meta-analysis.

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  Fig. 4 Recurrence-free survival based on reconstructed Kaplan–Meier survival data. Survival data of 3,512 patients in both groups were reconstructed from survival curves of original articles and presented.

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