Hepatocellular carcinoma (HCC): Resection with adjuvant hepatic artery infusion chemotherapy (HAIC) versus resection alone—A systematic review and meta-analysis.

Abstract

357 Background: HCC have a recurrence rate of up to 70% in 5 years after resection detrimentally lowering survival. The role of adjuvant HAIC in management of HCC in patients who are not candidates for transplantation is controversial. We aimed to evaluate overall and disease free survival in these patients. Methods: A comprehensive online search of MEDLINE, EMBASE, PubMed, SCOPUS and the Cochrane database was conducted (Jan 1994 - August 2016). Comparative studies including patients with HCC, who are not transplant candidates, undergoing surgical resection and adjuvant HAIC vs surgical resection alone were reviewed. Study quality was assessed using STROBE checklist. Pooled risk ratios and 95% confidence intervals (CI) for overall and disease-free survival at 1, 3 and 5 years were calculated. Results: Overall, 10 studies with 595 HCC patients were included; 283 underwent resection followed by HAIC and 312 underwent resection alone. Mean age was 61 ± 10.1 years with a male/female ratio of 6/1. Meta-analysis of all included studies showed better overall survival in patients undergoing resection followed by HAIC compared with resection alone at 1-YR (Average 90.1% vs 79.5%, RR:1.15, CI:1.07 – 1.24, p=0.095, NS), 3-YR (Average 72.1% vs 49.4%, RR:1.57, CI:1.34 – 1.77, p<0.01) and 5-YR (Average 51% vs 30.2%, RR:1.71, CI:1.33 – 2.20, p<0.01). Median survival time for the resection with HAIC group was 54.94 months compared to 31.5 months for the resection alone group. In addition, disease-free survival was better with HAIC at 1-YR (RR:1.36, CI:1.21 – 1.54, p<0.01), 3-YR (RR:1.59, CI:1.27 – 1.98, p<0.01) and 5-YR (RR:1.85, CI:132. – 2.61, p=0.011). The median disease-free survival time for the resection with HAIC group was 17.5 months compared to 7.35 months for the resection alone group. Subgroup analysis showed that this survival advantage was more significant in patients with tumors ≥7cm (p<0.05). Conclusions: Combination of HCC resection with HAIC improve overall and disease-free survival of patients with HCC who are not candidates for transplantation, especially in tumors ≥ 7cm.