Comparative survival analysis of adjuvant therapy with iodine-131-labeled lipiodol to hepatic resection of primary hepatocellular carcinoma: a meta-analysis.
OBJECTIVE
Adjuvant therapies play an important role in delaying the recurrence of hepatocellular carcinoma (HCC) in patients with resectable tumor. Among the available options, use of radionuclides is an effective strategy. This meta-analysis aims to examine the evidence pertaining to the effectiveness of adjuvant therapy with intra-arterial iodine-131-labeled lipiodol ((131)I-lipiodol) to hepatic resection of HCC.


METHODS
A literature survey was conducted of multiple electronic databases including PubMed/Medline, Embase, CINAHL, Cochrane library, and Google Scholar using various combinations of the most relevant key terms. The odds ratio-based meta-analysis of recurrence and survival rates was performed with RevMan software (version 5.2) using a random-effect model. Heterogeneity was assessed by χ(2) and I(2) statistics.


RESULTS
When compared with the resection-only group, recurrence rates at 2 and 5 years were significantly lower in patients who received adjuvant therapy with intra-arterial I-lipiodol, with a corresponding odds ratio (95% confidence interval) of 0.45 (0.29-0.70) and 0.52 (0.32-0.85), respectively. The 3- and 5-year overall survival rates were found to be significantly higher in patients who received adjuvant therapy with (131)I-lipiodol than in patients who were not given any adjuvant therapy. Between-study statistical heterogeneity was moderate.


CONCLUSIONS
Postoperative adjuvant therapy with intra-arterial (131)I-lipiodol to hepatic resection of HCC significantly improves overall and disease-free survival rates and reduces recurrence rates. However, well-designed randomized trials are needed to arrive at conclusive evidence.
aDepartment of Hepatobiliary Surgery, Chinese PLA General Hospital bDepartment of Hepatobiliary Surgery, No. 401 Hospital of Chinese PLA, Qingdao cMilitary Medical Science Academy of PLA, Beijing dDepartment of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
Lin
L
Gong
Lu
L
Shi
Jing
J
Sun
Wei-Sheng
WS
Yuan
Jian-Feng
JF
Chen
Peng
P
Liu
Feng
F
Gong
Jia-Hong
JH
Dong
D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004998:Ethiodized Oil / Q000627:therapeutic use*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate
D007457:Iodine Radioisotopes; D004998:Ethiodized Oil