Ann Surg Treat Res.  2022 Nov;103(5):280-289. 10.4174/astr.2022.103.5.280.

Comparing efficacies of different treatment regimens in patients with hepatocellular carcinoma accompanied by portal vein tumor thrombus using network meta-analysis

• Lee S
• Song SK
• Bae B
• Park Y

• KMID: 2534851
• DOI: http://doi.org/10.4174/astr.2022.103.5.280

Abstract

Purpose
Although various treatment regimens have been introduced for hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombosis (PVTT), comprehensive and direct comparisons between them are limited. Thus, the purpose of this study was to perform a network meta-analysis (NMA) to compare the efficacies of different treatment regimens for HCC accompanied by PVTT.
Methods
A systematic review was conducted to identify studies comparing 2 or more treatment regimens for HCC accompanied by PVTT without extrahepatic metastasis and reporting each overall survival (OS). Endpoints of this NMA were to hazard ratios with confidential intervals for OS and mean survival time difference of each treatment regimen comparison using a random-effects model. Each treatment regimen was then ranked using the P-score to assess the probability of the superiority of each one.
Results
Eleven studies involving 1,623 patients that yielded 16 comparisons were identified and enrolled in this NMA. There were 12 different treatment regimens as comparators, including sorafenib therapy alone (reference treatment). The NMA suggested that the following 4 treatment regimens improved OS compared to sorafenib: surgical resection followed by portal vein chemotherapy (SR plus PVC), SR, radiofrequency ablation plus sorafenib, and transarterial chemoembolization combined with selective internal radiation therapy. SR plus PVC was ranked the best treatment regimen for OS (P-score, 93.9%).
Conclusion
Comparative efficacy based on this NMA may help clinicians select treatment for HCC accompanied by PVTT. If amenable, aggressive locoregional treatment regimens such as SR plus PVC should be considered for HCC accompanied by PVTT.

Keyword

Carcinoma; Hepatectomy; Hepatocellular; Portal vein; Radiotherpay; Sorafenib

Figure

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  Fig. 1 Flow chart showing study selection process and search results.

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  Fig. 2 Modified Newcastle-Ottawa Scale assessment of selected studies.

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  Fig. 3 Network of studies for network meta-analysis applying treatments for patients with hepatocellular carcinoma accompanied by portal vein tumor thrombus. PVC, portal vein chemotherapy; EBRT, external beam radiation therapy; TACE, transarterial chemoembolization; BSC, best supportive care; TARE, transarterial radioembolization; SIRT, selective internal radiation therapy; RFA, radiofrequency ablation.

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  Fig. 4 Forest plot depicting hazard ratio (HR) of overall survival after each treatment in patients with hepatocellular carcinoma accompanied by portal vein tumor thrombus compared to systemic therapy with sorafenib using random-effect models. CI, confidence interval; EBRT, external beam radiation therapy; RFA, radiofrequency ablation; SIRT, selective internal radiation therapy; PVC, portal vein chemotherapy; TACE, transarterial chemoembolization; TARE, transarterial radioembolization.

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  Fig. 5 Forest plot depicting mean difference (MD) of survival after each treatment in patients with hepatocellular carcinoma accompanied by portal vein tumor thrombus compared to systemic therapy with sorafenib using random-effect models. CI, confidence interval; EBRT, external beam radiation therapy; RFA, radiofrequency ablation; SIRT, selective internal radiation therapy; PVC, portal vein chemotherapy; TACE, transarterial chemoembolization; TARE, transarterial radioembolization.

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