Background: For patients with hepatocellular carcinoma (HCC) who have high-risk recurrence factors following hepatectomy, there is currently no comprehensive meta-analysis examining the effects of various adjuvant therapies post-resection. The comparative effectiveness of these different adjuvant therapies remains unclear. Consequently, we conducted a review of available trials involving postoperative adjuvant therapies in patients with HCC who underwent radical resection and presented with factors associated with a high risk of recurrence.
Method: We collected all studies on postoperative adjuvant therapies in HCC patients with high-risk recurrence factors, concluding on September 7, 2024, from PubMed, Embase and Web of Science. In these studies, overall survival (OS) and disease-free survival (DFS) were compared between groups by calculating the combined hazard ratios (HRs) and 95% confidence intervals (CIs).
Result: Forty-five eligible trials (8,409 patients) reporting five different therapies were included. Our results indicated that postoperative adjuvant therapies such as TACE, TKI, RT, and HAIC-FOLFOX are effective. In terms of improving the DFS, RT (HR = 0.31, 95%CI: 0.18-0.52) was found to be the most effective adjuvant therapy, followed by TKI (HR = 0.48, 95%CI: 0.36-0.63). Regarding OS improvement, RT (HR = 0.31, 95%CI: 0.19-0.50) demonstrated the highest effectiveness, followed by TKI (HR = 0.50, 95%CI: 0.38-0.66).
Conclusion: Adjuvant therapy following hepatectomy decreases the risk of recurrence, and HCC patients with high risks of recurrence may benefit. TACE, TKI, RT and HAIC-FOLFOX are effective methods for reducing recurrence after HCC with high risks of recurrence. RT appears to be the most effective adjuvant regimen.
Keywords: adjuvant therapy; hepatocellular carcinoma; meta-analysis; recurrence; survival.
Copyright © 2025 Zhao, Yi, Xiao, Li and Liu.