Comparing the long-term efficacy of standard and combined minimally invasive procedures for unresectable HCC: a mixed treatment comparison

Abstract

A small proportion of hepatocellular carcinoma (HCC) patients are suitable for surgical resections and various minimally invasive procedures have been introduced as alternatives to surgical resections. However, the relative efficacy of minimally invasive procedures remains to be studied in the current literature. Several popular minimally invasive procedures (monotherapy or combined therapies) were selected for comparison and their relative long-term efficacy were determined by using the statistics of hazard ratio (HR) which evaluates the survival status of HCC patients in one, two, three and four years, respectively. Evidence were obtained from the current literature and synthesized by using the approach of conventional pairwise meta-analysis and network meta-analysis (NMA). Moreover, selected minimally invasive procedures were ranked according to their surface under the cumulative ranking curve (SUCRA) which was produced by NMA in conjunction with the Markov Chain Monte Carlo (MCMC) sampling method. HCC patients treated by combined minimally invasive procedures, particularly transcatheter arterial chemoembolization (TACE) + high intensity focused ultrasound (HIFU), TACE + radiofrequency ablation (RFA), TACE + radiotherapy (RT) and TACE + Sorafenib (SOR) exhibited a significant decrease in the HR compared to those with standard TACE (HR < 1). The combined minimally invasive procedure of TACE + HIFU appears to be the most preferable therapy. PEI seems to be less favorable than other minimally invasive procedures. Combined minimally invasive procedures may be more preferable than standard minimally invasive procedures. Percutaneous ethanol injection (PEI) may not provide adequate efficacy compared to other minimally invasive procedures for unresectable HCC patients.

P57‐mediated autophagy promotes the efficacy of EGFR inhibitors in hepatocellular carcinoma

“…Hepatocellular carcinoma (HCC) has been identified as one of the most common and lethal malignancies globally . Although advances in diagnosis and treatment of HCC have been achieved, improving the prognosis of patients with advanced disease remains a major challenge …”

“…1 Although advances in diagnosis and treatment of HCC have been achieved, improving the prognosis of patients with advanced disease remains a major challenge. 2 EGFR (epidermal growth factor receptor) is a member of the ErbB family, and is commonly expressed in a variety of malignant epithelial cells. 3 Despite the overexpression of EGFR in human HCC, therapeutic responses to EGFR-inhibitors have only been seen in a minority of patients.…”

Efficacy and safety of high-intensity focused ultrasound ablation for hepatocellular carcinoma by changing the acoustic environment: microbubble contrast agent (SonoVue) and transcatheter arterial chemoembolization

“…Previous studies proved that the TACE þ HIFU combination therapy was much more effective and had a superior overall survival rate than treatment only by HIFU or TACE for patients with HCC [22,23]. In addition, another study reported that combined minimally invasive therapy was much more effective than a single therapy that can certainly improve the long-term survival of patients, and among them, HIFU combined with TACE might be a more effective approach [24]. For lesions, iodized oil deposition after TACE treatment can help identify the location of the lesion and decrease blood supply to reduce the 'blood cooling' effect.…”

Impact of local tumor lesion treatments and preoperative indicators on the survival of patients with small hepatocellular carcinomas

“…The observation of high-risk patients increases the early detection of SHCC but there are still a number of patients with SHCC who cannot undergo surgery by the time SHCC is diagnosed ( 25 ). To date, the treatment of SHCC remains a critical issue ( 26 , 27 ). Three aspects of this problem have been addressed in the present study.…”