title: A meta-analysis of adjuvant therapy after potentially curative treatment for hepatocellular carcinoma.
abstract: BACKGROUND
  The high recurrence rate of hepatocellular carcinoma (HCC) after potentially curative treatment determines the long-term prognosis.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of adjuvant therapies in patients with HCC who have undergone hepatic resection, transplantation or locoregional ablation therapy.
  
  
  METHODS
  Several databases were searched to identify randomized controlled trials (RCTs) fulfilling the predefined selection criteria. Meta-analyses were performed to estimate the effects of adjuvant therapies of any modality on recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  Eight adjuvant modalities were identified from 27 eligible RCTs conducted predominantly in Asian populations comparing adjuvant with no adjuvant therapy. Adjuvant chemotherapy, internal radiation and heparanase inhibitor PI-88 therapy failed to improve RFS or OS, while interferon (IFN) therapy yielded significant survival results. The findings of adjuvant vitamin analogue therapy required further examination. Adjuvant adoptive immunotherapy conferred significant benefit for RFS but not for OS. Although cancer vaccine therapy and radioimmunotherapy may improve survival after radical surgery, the results were from single, small-scale trials. Severe side effects were observed in the studies of adjuvant chemotherapy and of IFN therapy.
  
  
  CONCLUSIONS
  Adjuvant IFN therapy can improve both RFS and OS; however, the benefits of using this agent should be weighed against its 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. Additional RCTs with proper design are required to establish the role of adjuvant therapies for HCC.
authors.affiliation: Department of General Surgery, The First Hospital of Lanzhou University, Gansu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Xiao Dong
authors.initials: XD
authors.lastname: He
authors.forename: Nan
authors.initials: N
authors.lastname: Yao
authors.forename: Wen Jia
authors.initials: WJ
authors.lastname: Liang
authors.forename: You Cheng
authors.initials: YC
authors.lastname: Zhang
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019496:Cancer Vaccines / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D055502:Secondary Prevention; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D007372:Interferons