1Upper Gastrointestinal Surgery and Transplant unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia, email@example.com.
Curative resection for hepatocellular carcinoma (HCC) has an 80 % recurrence at 5 years. Survival could be prolonged with adjuvant iodine131 lipiodol. This systematic review and meta-analysis was designed to assess the survival benefit of this treatment in patients with resected HCC compared with surgery alone.
Studies were identified through a systematic search of MEDLINE, EMBASE, PubMed, and Cochrane databases in June 2013. Three case-control series and two randomized, controlled trials (RCT) were included. Two of these studies had a second publication that analyzed long-term follow-up. Two reviewers extracted data with respect to disease-free and overall survival (OS). The data from the seven studies was then subject to meta-analysis.
Age, sex, liver function, tumor size, encapsulation, microvascular invasion, multifocality, and the rate of major hepatic resection were similar in the two groups. Peto odds ratio for disease-free survival was 0.47 (95 % confidence interval (CI) 0.37-0.59, I 2 = 10 %) and for OS was 0.5 (95 % CI 0.39-0.64, I 2 = 37 %), in favor of treatment.
This study is limited by its comparison of two RCTs with three case-control studies. Most patients also had preserved liver function, and there was a generally low rate of microvascular invasion. Nonetheless, there is strong evidence for the use of adjuvant I131 lipiodol, to prolong disease-free and OS, up to 5 years after resection.