Therapies for Patients with Hepatocellular Carcinoma Awaiting for Liver Transplantation: a Systematic Review and Meta-analysis.
Kulik L, Heimbach JK, et al.Hepatology 2017; 31: 31.
Aims
To conduct a systematic review and meta-analysis to synthesize existing evidence about the effectiveness of loco-regional therapy (LRT) in the management of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation.
Interventions
The databases Medline, Embase, Cochrane Central Register of Controlled Trials and Scopus were searched from inception until 25th April 2016 for comparative and non-comparative studies in any language that enrolled adults with cirrhosis awaiting liver transplantation and treated with bridging or down-staging therapies before transplant. Therapies included trans-catheter arterial chemoembolization (TACE), trans-arterial radio embolization (TARE), ablation or radiotherapy. Two reviewers independently screened titles and abstracts for potential eligibility.
Participants
63 studies were included in the analysis.
Outcomes
Measured outcomes included waitlist dropout rate due to progression and/or due to any causes, post-transplantation mortality and survival rates, and post-transplantation recurrence and recurrence free survival rates.
Follow-up
Variable across studies
CET Conclusions
This systematic review examined the evidence of loco-regional therapy (i.e. trans-catheter arterial chemoembolization (TACE), trans-arterial radio-embolization (TARE), ablation or radiotherapy) in patients with hepatocellular carcinoma who are waitlisted for liver transplantation. The comprehensive bibliographic search was designed by an information specialist. Risk of bias of included studies was independently assessed by two reviewers using the Newcastle-Ottawa Scale. The quality of evidence was rated very low using the GRADE criteria. The review included 63 studies and addressed a number of clinical questions. No firm conclusions can be drawn regarding the effectiveness of loco-regional therapies due to the limited available evidence and the very low quality of the evidence.
Quality notes
Quality assessment not appropriate
Trial registration
None