Effects of interferon alpha treatment on recurrence and survival after complete resection or ablation of hepatocellular carcinoma: A meta‐analysis of randomized controlled trials

Abstract

Available literature on the benefit of interferon alpha (IFN-a) as adjuvant postsurgical or ablative treatment of hepatocellular carcinoma reports discordant results. By meta-analysis of the available data, we evaluated the effects of IFN-a on recurrence and survival after complete resection or ablation of hepatocellular carcinoma. All randomized controlled trials comparing IFN-a with placebo or no treatment after tumor resection or ablation were selected. Finally, 6 studies published in 2001 or later with a total of 600 patients were included in this meta-analysis. Data on postsurgical or ablative early recurrence and 1 year survival of hepatocellular carcinoma in IFN-a treated and untreated patients were extracted from each study. Proportions were combined, and the odds ratio (OR) with its 95% confidence interval (CI) was used as the effect size estimate. Analysis results show that IFN-a significantly decreased postsurgical or ablative overall early recurrence (OR 5 0.62; 95% CI 5 0.42-0.93; p 5 0.02) and improved overall 1 year survival (OR 5 3.14; 95% CI 5 1.79-5.52; p < 0.0001). Subgroup analyses show that IFN-a decreased postsurgical early recurrence (OR 5 0.58; 95% CI 5 0.37-0.91; p 5 0.02) and improved 1 year survival (OR 5 3.19; 95% CI 5 1.80-5.67; p < 0.0001) evidently. Subgroup analyses also show that IFN-a reduced early recurrence after resection without pre-resection ablation therapy (OR 5 0.58; 95% CI 5 0.37-0.91; p 5 0.02) and improved 1 year survival (OR 5 3.83; 95% CI 5 2.01-7.27; p < 0.0001). These results suggest that IFN-a treatment could significantly decrease early recurrence and improve 1 year survival of patients with hepatocellular carcinoma after complete resection or ablation. The use of IFN-a as adjuvant postsurgical or ablative treatment seems promising but requires further study. ' UICCKey words: hepatocellular carcinoma; IFN-a; recurrence; survival; resection; ablation Hepatocellular carcinoma (HCC) is one of the most common and aggressive malignant tumors in Asia and Africa, and it is a significant cause of death in eastern Asia and sub-Saharan Africa. 1,2 Because most patients with HCC are diagnosed at intermediate to advanced stages and there is no standard treatment for these patients, only a minority of patients are eligible for potentially curative treatments. 3,4 Among curative treatments, liver transplantation is a good choice for both HCC and the underlying cirrhosis, which theoretically eliminates both the tumor as well as the underlying liver disease; but it can only be performed on a small proportion of patients due to graft availability, selection criteria, high cost, etc. 5,6 Thus, liver resection or perhaps tumor ablation remains the only available curative treatment in many situations. 5 Liver resection is still considered as the first-line therapeutic option for most patients with HCC, and it is regarded as a standard treatment that can offer an opportunity of cure for patients with localized tumors and preserved liver function. 7,8 Besides, currently local ablat...

Effect of Adjuvant Interferon Therapy on Hepatitis B/C Virus-Related Hepatocellular Carcinoma After Curative Therapy - Meta-Analysis

“…Subgroup analysis of both the median tumor size less than 3 cm and more than 3 cm groups showed the same result in survival. The result is in accord with other meta-analyses before [29,30,36,37]. We reasoned this phenomenon as follows: firstly, IFN can relieve active-hepatitis and improving hepatic fibrosis and liver function; to be next, decrease the severity of a recurrent tumor and thus be amenable to secondary curative ablation or resection.…”

Adjuvant Therapy after Curative Treatment for Hepatocellular Carcinoma

“…Recently, 2 reviews [19,20] and 6 meta-analyses [21,22,23,24,25,26] were published regarding the recurrence-preventing or survival-prolonging effect of IFN therapy after the resection or ablation of HCC. All of them suggested that IFN is effective in preventing recurrence or improving survival.…”

Safety and efficacy of adjuvant pegylated interferon therapy for metastatic tumor antigen 1‐positive hepatocellular carcinoma

“…[31][32][33][34] Although these suppressive effects of IFN on recurrence of HCC are still controversial, several meta-analyses have demonstrated that IFN has a significant beneficial effect after curative treatment for HCC in terms of both survival and tumor recurrence. 2,35 Such various results regarding IFN therapy suggest that IFN used postoperatively may inhibit or at least retard HCC recurrence in part if applied carefully under highly selected conditions, like MTA1-positive HCC, and is not for all patients. On the basis of this hypothesis, for the current study, we enrolled only patients who had a high risk of a postoperative HCC recurrence and who were screened for MTA1 overexpression.…”

“…The areas of the most intense staining and predominant patterns were scored. Staining intensity was graded as negative (0% [2]), weakly positive (<50% [1]), and strongly positive (>50% [11]), depending on the proportion of positive tumor cells.…”