Harms and benefits of adoptive immunotherapy for postoperative hepatocellular carcinoma: an updated review

Bao-Hong Yuan,Jian-Hong Zhong,Le-Qun Li,Tie-Jun Tong,Tian Yang,Ru-Hong Li,Ning-Fu Peng,Wei-Ping Yuan

doi:10.18632/oncotarget.14507

Abstract

The harms and benefits of adoptive immunotherapy (AIT) for patients with postoperative hepatocellular carcinoma (HCC) are controversial among studies. This study aims to update the current evidence on efficacy and safety of AIT for patients with HCC who have received curative therapy. Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and cohort studies evaluating adjuvant AIT for patients with HCC after curative therapies. Recurrence and mortality were compared between patients with or without adjuvant AIT. Eight RCTs and two cohort studies involving 2,120 patients met the eligibility criteria and were meta-analyzed. Adjuvant AIT was associated with significantly lower recurrence rate than curative therapies alone at 1 year [risk ratio (RR) 0.64, 95%CI 0.49-0.82], 3 years (RR 0.85, 95%CI 0.79-0.91) and 5 years (RR 0.90, 95%CI 0.85-0.95). Similarly, adjuvant AIT was associated with significantly lower mortality at 1 year (RR 0.64, 95%CI 0.52-0.79), 3 years (RR 0.73, 95%CI 0.65-0.81) and 5 years (RR 0.86, 95%CI 0.79-0.94). Short-term outcomes were confirmed in sensitivity analyses based on RCTs or choice of a fixed- or random-effect meta-analysis model. None of the included patients experienced grade 3 or 4 adverse events. Therefore, this update reinforces the evidence that adjuvant AIT after curative treatment for HCC lowers risk of recurrence and mortality.

Highlights

Official guidelines [1, 2] identify hepatic resection and radiofrequency ablation (RFA) as two mainstay curative treatments for very early or early hepatocellular carcinoma (HCC)
This study aims to update the current evidence on efficacy and safety of adoptive immunotherapy (AIT) for patients with HCC who have received curative therapy
HCC is associated with a high recurrence rate, even after curative treatment; recurrence is the primary cause of death of all patients with HCC

Summary

Introduction

Official guidelines [1, 2] identify hepatic resection and radiofrequency ablation (RFA) as two mainstay curative treatments for very early or early hepatocellular carcinoma (HCC). Guidelines recommend transarterial chemoembolization (TACE) for intermediate or advanced HCC [1, 2], but progression-free survival (PFS) is unsatisfactory [5, 6]: even after more aggressive hepatic resection, the 5-year recurrence rate can be as high as 74% [7, 8]. These data indicate that even after curative surgery, patients with HCC have poor prognosis, highlighting the need for effective adjuvant therapies that improve patient outcomes. We wanted to perform an updated meta-analysis of the literature to gain a comprehensive www.impactjournals.com/oncotarget

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