Adjuvant interferon therapy after curative therapy for hepatocellular carcinoma (HCC): a meta-regression approach.
OBJECTIVE
Adjuvant anti-viral therapy after curative therapy for HCC has been studied extensively but the true clinical benefit and the predictors of efficacy remain unclear.


METHODS
MEDLINE, PubMed, and the Cochrane library were searched until December 2008, plus the meeting abstracts of the American Association for the Study of Liver Disease 2005-2008. Randomized trials and cohort studies were included if the studies (1) enrolled HCC patients who had underlying chronic viral hepatitis B or C and had undergone curative surgery or ablation therapy; (2) consisted of one or more treatment arms with interferon-based therapy and a control arm of no anti-viral therapy; and (3) included recurrence-free survival of HCC as an endpoint. Meta-analysis and meta-regression were done according to the Cochrane guidelines.


RESULTS
Thirteen studies (9 randomized trials and 4 cohort studies, totally 1180 patients) were eligible for meta-analysis. Surgery and ablation therapy were used in 9 and 8 studies, respectively. All studies used conventional interferon (natural or recombinant) as anti-viral therapy. Overall, interferon improved the 1-year, 2-year, and 3-year recurrence-free survival by 7.8% (95% CI 3.7-11.8%), 35.4% (95% CI 30.7-40.0%), and 14.0% (95% CI 8.6-19.4%), respectively (all p<0.01). Lower percentage of patients with multiple tumors and use of ablation therapy were independent predictors for better treatment efficacy.


CONCLUSIONS
The quantitative estimation of treatment efficacy and the identification of predictive factors in this study will help design future clinical trials of adjuvant therapy for HCC.
Shen
Ying-Chun
YC
Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Hsu
Chiun
C
Chen
Li-Tzong
LT
Cheng
Chia-Chi
CC
Hu
Fu-Chang
FC
Cheng
Ann-Lii
AL
D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000601:surgery / Q000821:virology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000821:virology; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D055502:Secondary Prevention
D000998:Antiviral Agents; D007372:Interferons