title: Adjuvant therapy options following curative treatment of hepatocellular carcinoma: a systematic review of randomized trials.
abstract: OBJECTIVE
  Numerous postoperative therapies for preventing recurrence of hepatocellular carcinoma (HCC) have been reported, but their efficacy remains controversial and knowledge about adverse effects is limited. A systematic review of randomized controlled trials (RCTs) was performed to gain a comprehensive picture of the efficacy and risks of these therapies.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Library were systematically searched through July 2011. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  A total of 2989 patients from 28 RCTs involving 10 postoperative therapies were included. For interferon therapy, the estimated RR for the 2-year recurrence rate was 0.84 (95% CI 0.73-0.97, P = 0.02) and the overall survival (OS) was 1.15 (95% CI 1.07-1.22, P < 0.001). Postoperative therapy with the vitamin K2 analog did not lead to a significant reduction in the 1-year recurrence rate, with a pooled RR of 0.60 (95% CI 0.28-1.27, P = 0.18). However, it did slightly improve the 1-year OS, with a pooled RR of 1.03 (95% CI 1.00-1.05, P = 0.03). Transarterial chemotherapy with or without embolization, adoptive immunotherapy and heparanase inhibitor PI-88 therapy may delay tumor recurrence. The effects of acyclic retinoid, lipiodol-iodine-131 and tumor vaccine treatment were promising but require further study. All postoperative therapies except interferon administered intramuscularly were well tolerated by the majority of patients.
  
  
  CONCLUSIONS
  Use of adjuvant interferon is definitely associated with an increase in OS. Postoperative therapies involving acyclic retinoid, lipidol-iodine-131, or tumor vaccine may improve the OS of patients with HCC after curative treatment.
authors.affiliation: Hepatobiliary Surgery Department, Tumor Hospital of Guangxi Medical University, He Di Rd. #71, Nanning 530021, PR China.
authors.forename: J-H
authors.initials: JH
authors.lastname: Zhong
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: L-Q
authors.initials: LQ
authors.lastname: Li
authors.forename: X-M
authors.initials: XM
authors.lastname: You
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.forename: Y-N
authors.initials: YN
authors.lastname: Zhao
authors.forename: J-Y
authors.initials: JY
authors.lastname: Liu
authors.forename: B-D
authors.initials: BD
authors.lastname: Xiang
authors.forename: G-B
authors.initials: GB
authors.lastname: Wu
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D007372:Interferons / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D007372:Interferons