The Evidence-based Study Of Theraples In Hepatocellular Carcinoma

Background and aims:Primary liver cancer, particularly hepatocellular carcinoma (HCC), is one of the most common malignances worldwide. In china, the morbidity and mortality of HCC are high. Given the lacking of evidence-based clinical studies or controversial issues in trials of therapies for HCC, the aim of the current study was twofold: to review available high-quality clinical studies in HCC, from these to locate some potential questions that are either controversial or require further evaluation; and to solve these questions by using meta-analytic methods.Methods:Several databases were searched for randomized controlled trials (RCTs) and meta-analysis or systematic reviews (SR) in HCC. This was conducted in December,2011. The retrieved articles were scanned and were categorized into several study groups with regard to etiology, diagnosis, prevention, and treatment and prophylaxis of HCC.Results:The absence of high-quality evidence of interventions is main challenge in HCC clinical research. From279RCTs of intervention, two study topics were indentified, which were then entitled as "Adjuvant therapy after potentially curative treatment for HCC"(The first study) and "Antibiotic prophylaxis in transarterial therapy of HCC"(The second study). We performed meta-analysis for either of the two topics following criteria recommended by Cochrane handbook for systematic reviews of interventions. The first study included27RCTs and the results demonstrated that adjuvant chemotherapy, internal radiation therapy and heparanase inhibitor PI-88therapy failed to improve recurrence-free or overall survival, while interferon therapy or adoptive immunotherapy showed promising results. The findings of adjuvant vitamin analogue therapy need to be further examined. Cancer vaccine therapy and radioimmunotherapy may confer survival benefits after radical surgery, which were however tested in small-scale and preliminary settings. The results of the meta-analysis of the second study involving4clinical trials showed that the incidence of infection after transarterial procedure of HCC was rare. The rate of patients developing fever, changes in peripheral white blood cell counts or serum C-reactive protein levels, and the mean length of hospital stay showed no significant inter-group differences between antibiotic and no antibiotic treatment.Conclusions:The prognosis of patients with HCC is poor, and there are few RCTs of therapy that are available for meta-analytic evaluation. Adjuvant IFN therapy can improve both RFS and OS, but the benefits of using this agent should be weighed against side effects. Combination of systemic and transhepatic arterial chemotherapy is not recommended for HCC after potentially curative treatment. Other adjuvant therapies produce limited success for survival. Further RCTs with proper design are required to establish the role of adjuvant therapies for HCC. Routinely use of prophylactic antibiotics against post-procedure infection in patients undergoing transarterial therapy of HCC may be unnecessary. However, a more judicious use of antibiotics is recommended for patients with increased risk of infection.