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Hepatocellular Carcinoma in Liver Cirrhosis: Surgical Resection versus Transarterial Chemoembolization-A Meta-Analysis.

Kapitanov T, Neumann UP, Schmeding M - Gastroenterol Res Pract (2015)

Bottom Line: The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified.The hazard ratio of overall-survival for all twelve studies was 0.70 (P = 0.0001) and significantly in favor of surgical treatment.Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Pauwelstraße 30, 52074 Aachen, Germany.

ABSTRACT
We compare the value of TACE to liver resection for patients with BCLC stage A and B HCC. For patients with HCC in cirrhosis LT is the treatment of choice. TACE represents the current standard for unresectable BCLC stage B patients not eligible for LT. Recently liver resection for HCC and significant cirrhosis has become increasingly popular. A systematic search of the literature and meta-analysis was conducted to identify studies, reporting short- and long-term results of hepatic resection versus TACE for HCC treatment. The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified. Peri-interventional mortality and overall survival were investigated. Peri-interventional mortality was higher for surgical resection (n.s.), and overall-survival was significantly better for surgically treated patients at one year (P = 0.002) and 3 years (P ≤ 0.00001). The hazard ratio of overall-survival for all twelve studies was 0.70 (P = 0.0001) and significantly in favor of surgical treatment. Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients.

No MeSH data available.


Related in: MedlinePlus

Funnel plot at 3-year overall-survival depicting the distribution of hazard ratios for the 12 studies included in the meta-analysis. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of reporting biases and heterogeneity. The solid vertical lines correspond to no intervention effect.
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Related In: Results  -  Collection


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fig5: Funnel plot at 3-year overall-survival depicting the distribution of hazard ratios for the 12 studies included in the meta-analysis. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of reporting biases and heterogeneity. The solid vertical lines correspond to no intervention effect.

Mentions: All studies identified in our literature search reported the short- and long-term survival in the form of Kaplan-Meier curves. The number of patients event-free at each time point within a Kaplan-Meier curve is known and can be used to estimate the amount of censoring in a trial [24]. The methods to extract and calculate these statistics data have been described in detail by Tierney et al. [25] and Parmar et al. [26]. A calculation spreadsheet in Microsoft Excel was developed to obtain the observed minus expected events (O-E), the variance V, the hazard ratio HR, the log hazard ratio, and its standard error SE for each individual trial. Statistical analysis was undertaken using Review Manager software version 4.2.7 (the Cochrane Collaboration, Oxford, UK). The end points of this meta-analysis were 30-day or in-hospital mortality and short- and long-term overall-survival. The effect measures for 30-day mortality were described in odds ratios (ORs) and the overall-survival rates were expressed as hazard ratios (HRs). Random effects model was used because of heterogeneity among the studies. Meta-analysis was displayed graphically as “forest plots.” Heterogeneity was explored using chi-squared test. I2 value was calculated to measure and quantify heterogeneity. Funnel plot (Figure 5) was used to examine reporting bias and heterogeneity in the results of meta-analyses. Statistical significance of the overall result was expressed with the probability value (P value). The result was regarded as statistically significant if P < 0.05.


Hepatocellular Carcinoma in Liver Cirrhosis: Surgical Resection versus Transarterial Chemoembolization-A Meta-Analysis.

Kapitanov T, Neumann UP, Schmeding M - Gastroenterol Res Pract (2015)

Funnel plot at 3-year overall-survival depicting the distribution of hazard ratios for the 12 studies included in the meta-analysis. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of reporting biases and heterogeneity. The solid vertical lines correspond to no intervention effect.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4302354&req=5

fig5: Funnel plot at 3-year overall-survival depicting the distribution of hazard ratios for the 12 studies included in the meta-analysis. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of reporting biases and heterogeneity. The solid vertical lines correspond to no intervention effect.
Mentions: All studies identified in our literature search reported the short- and long-term survival in the form of Kaplan-Meier curves. The number of patients event-free at each time point within a Kaplan-Meier curve is known and can be used to estimate the amount of censoring in a trial [24]. The methods to extract and calculate these statistics data have been described in detail by Tierney et al. [25] and Parmar et al. [26]. A calculation spreadsheet in Microsoft Excel was developed to obtain the observed minus expected events (O-E), the variance V, the hazard ratio HR, the log hazard ratio, and its standard error SE for each individual trial. Statistical analysis was undertaken using Review Manager software version 4.2.7 (the Cochrane Collaboration, Oxford, UK). The end points of this meta-analysis were 30-day or in-hospital mortality and short- and long-term overall-survival. The effect measures for 30-day mortality were described in odds ratios (ORs) and the overall-survival rates were expressed as hazard ratios (HRs). Random effects model was used because of heterogeneity among the studies. Meta-analysis was displayed graphically as “forest plots.” Heterogeneity was explored using chi-squared test. I2 value was calculated to measure and quantify heterogeneity. Funnel plot (Figure 5) was used to examine reporting bias and heterogeneity in the results of meta-analyses. Statistical significance of the overall result was expressed with the probability value (P value). The result was regarded as statistically significant if P < 0.05.

Bottom Line: The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified.The hazard ratio of overall-survival for all twelve studies was 0.70 (P = 0.0001) and significantly in favor of surgical treatment.Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients.

View Article: PubMed Central - PubMed

Affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Aachen, RWTH Aachen, Pauwelstraße 30, 52074 Aachen, Germany.

ABSTRACT
We compare the value of TACE to liver resection for patients with BCLC stage A and B HCC. For patients with HCC in cirrhosis LT is the treatment of choice. TACE represents the current standard for unresectable BCLC stage B patients not eligible for LT. Recently liver resection for HCC and significant cirrhosis has become increasingly popular. A systematic search of the literature and meta-analysis was conducted to identify studies, reporting short- and long-term results of hepatic resection versus TACE for HCC treatment. The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified. Peri-interventional mortality and overall survival were investigated. Peri-interventional mortality was higher for surgical resection (n.s.), and overall-survival was significantly better for surgically treated patients at one year (P = 0.002) and 3 years (P ≤ 0.00001). The hazard ratio of overall-survival for all twelve studies was 0.70 (P = 0.0001) and significantly in favor of surgical treatment. Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients.

No MeSH data available.


Related in: MedlinePlus