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Review article: overview of medical treatments in unresectable hepatocellular carcinoma—an impossible meta‐analysis?
Author(s) -
Philippe Maury,
Olivier Rixe,
N. Carbonell,
Brigitte Bernard,
Philippe Cluzel,
MarieFrance Bellin,
David Khayat,
P Opolon,
Thierry Poynard
Publication year - 1998
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1998.00286.x
Subject(s) - medicine , percutaneous ethanol injection , tamoxifen , randomized controlled trial , hepatocellular carcinoma , fluorouracil , chemotherapy , meta analysis , oncology , odds ratio , surgery , gastroenterology , breast cancer , cancer , radiofrequency ablation , ablation
Background: Controversies surrounding medical treatment in patients with unresectable hepatocellular carcinoma continue to persist. Aim: To perform a meta‐analysis of therapeutic modalities which had been evaluated in two or more randomized trials. Methods: Fifty‐two randomized trials were studied; only 30 were included. This overview identified seven therapeutic modalities which had been evaluated in two or more trials: adriamycin, 5‐fluorouracil, interferon, percutaneous ethanol injection, transarterial chemotherapy, the combination of lipiodol with transarterial chemotherapy, and tamoxifen. Results: Comparisons of survival between control groups showed substantial heterogeneity. There was no survival benefit at 1 year with adriamycin (mean difference 4%), 5‐fluorouracil (mean difference −3%), percutaneous ethanol injection (mean difference 6%) or transarterial chemotherapy (mean difference −2%). For interferon, the survival benefit was significant with the Der Simonian & Laird method (mean difference 9%, 95% CI = 1–18%, P = 0.04) but not with the Peto et al . method (2.4 mean odds ratio, 95% CI = O.9–6.8). The meta‐analysis of tamoxifen showed a borderline survival benefit (mean difference 25%, 95% CI = 0–49%, P = 0.05). However, in sensitivity analyses, the survival benefit of tamoxifen was no longer significant. Conclusions: No treatment has clearly proven efficacy in survival. 5‐Fluorouracil, adriamycin and transarterial chemotherapy were not associated with survival benefit at 1 year. The number of randomized controlled trials was insufficient to enable a conclusion to be reached for interferon and percutaneous ethanol injection. Controversy persists concerning tamoxifen efficacy. Interferon and tamoxifen require new randomized controlled trials on a larger population of patients.