Comparison on the efficacy and prognosis of different strategies for intrahepatic recurrent hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis.

Background: Hepatocellular carcinoma (HCC) has a high rate of recurrence. This network meta-analysis aimed to compare the oncological prognosis of the conventional treatments for intrahepatic recurrent hepatocellular carcinoma (rHCC) and identify the optimal strategy. Methods: We conducted a literature search of online database, published between January 2009 and October 2019. Relevant studies analyzing the outcomes of the different interventions for rHCC were included. We synthesized the results using R software and the "gemtc" package. Results: A total of 21 studies involving 2818 patients were ultimately enrolled to be analyzed. We assessed five related therapeutic interventions and two oncological outcomes. The benefits orders of overall survival (OS) from largest to least were salvage liver transplantation (SLT), repeat hepatectomy (RH), radiofrequency ablation (RFA), stereotactic body radiation therapy (SBRT), and transarterial chemoembolization (TACE). For the benefits of recurrence-free survival (RFS), SLT and RH remained the top two treatments. Subgroup analysis of smaller (≤3 cm) and larger (>3 cm) tumour reached similar results. Consistency and heterogeneity analysis did not show significant inconsistency and heterogeneity. Discussion: Our findings demonstrated that SLT and RH were the best two treatments for rHCC. Nevertheless, the selection of strategies should also depend on tumour characteristics and basic health situation. [ABSTRACT FROM AUTHOR]

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