Comparative analysis of treatment modalities for solitary, small (≤3 cm) hepatocellular carcinoma: a systematic review and network meta-analysis of oncologic outcomes
Recommended Citation
Choi WJ, Ivanics T, Rajendran L, Li Z, Jones O, Gravely A, Claasen MP, Yoon P, Ladak F, Rana M, Gotlieb N, Dini Y, Naccarato K, McCluskey S, Ferreira R, Msallak H, Chow J, Abreu P, Rabindranath M, Selvanathan C, Muaddi H, Magyar C, Englesakis M, Hansen B, Sapisochin G. Comparative analysis of treatment modalities for solitary, small (≤3 cm) hepatocellular carcinoma: a systematic review and network meta-analysis of oncologic outcomes. HPB (Oxford) 2024; 26:S48-S49.
Document Type
Conference Proceeding
Publication Date
5-16-2024
Publication Title
HPB (Oxford)
Abstract
Introduction: Solitary hepatocellular carcinoma (HCC) measuring ≤3 cm represent approximately 30% of HCC cases, yet treatment guidelines lack robust evidence. This study compares oncologic outcomes following ablation, resection, and liver transplantation (LT) for solitary, small HCC. Methods: We systematically searched databases up to February 7, 2022, for studies including adults with solitary, small HCC (≤3 cm) treated by any ablation, resection, or LT. We excluded non-HCC cancers, recurrent/metastatic diseases, and alternative therapies. A frequentist network meta-analysis assessed 5-year overall survival (OS) and recurrence-free survival (RFS) using only adjusted effect estimates while accounting for bias risk. Results: We identified 81 studies (four RCTs, 73 retrospectives, and four prospective cohorts) with 28,333 patients. In the network meta-analysis for 5-year OS (26 studies), LT had the best outcome (HR 0.47 [95% CI 0.31-0.73, referenced to resection]), followed by resection (reference), while ablation had the least favorable outcome (HR 1.32 [95% CI 1.16-1.49, referenced to resection]). For 5-year RFS (19 studies), LT had the best outcome (HR 0.36 [95% CI 0.20-0.63, referenced to resection]), followed by resection (reference), with ablation showing the least favorable outcome (HR 1.67 [95% CI 1.45-1.93, referenced to resection]). Conclusion: This network meta-analysis provides the highest-level evidence for comparing treatment modality outcomes for solitary, small HCC. LT emerges as the superior choice for achieving a better 5-year OS, followed by resection, then ablation. When feasible to preserve liver function, resection can be prioritized. Ablation with close surveillance should be reserved for individuals unfit for surgical or LT procedures. [Formula presented] [Formula presented]
Volume
26
First Page
S48-S49
