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lüll Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma Mathurin P; Raynard B; Dharancy S; Kirzin S; Fallik D; Pruvot FR; Roumilhac D; Canva V; Paris JC; Chaput JC; Naveau SAliment Pharmacol Ther 2003[May]; 17 (10): 1247-61AIM: To evaluate adjuvant modalities after curative resection for hepatocellular carcinoma using a meta-analysis of randomized and non-randomized controlled trials. METHODS: In a first step, a meta-analysis of randomized controlled trials was carried out. Sensitivity analyses after inclusion of non-randomized controlled trials were performed. Four therapeutic modalities were evaluated: pre-operative transarterial chemotherapy, post-operative transarterial chemotherapy, systemic chemotherapy and a combination of systemic and transarterial chemotherapy. RESULTS: Only post-operative transarterial chemotherapy improved survival significantly at 2 years [difference, 22.8%; confidence interval (CI), 8.6-36.9%; P = 0.002] and 3 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005), and decreased the probability of no recurrence at 1 year (difference, 28.8%; CI, 16.7-40.8%; P < 0.001), 2 years (difference, 27.6%; CI, 8.2-47.1%; P = 0.005) and 3 years (difference, 28%; CI, 8.2-47.9%; P = 0.006). In a sensitivity analysis after inclusion of non-randomized controlled trials, post-operative transarterial chemotherapy still improved survival at 1 year (difference, 9.6%; CI, 0.8-18.3%; P = 0.03), 2 years (difference, 13.5%; CI, 0.9-26%, P = 0.04) and 3 years (difference, 18%; CI, 7-28.9%; P < 0.001), and decreased the probability of no recurrence at 1 year (difference, 20.3%; CI, 7.7-33%; P = 0.002), 2 years (difference, 35%; CI, 21.4-46.3%; P < 0.001) and 3 years (difference, 34.5%; CI, 18.7-50.3%; P < 0.001). CONCLUSION: Post-operative transarterial chemotherapy improved survival and decreased the cumulative probability of no recurrence. New randomized controlled trials evaluating this modality are required.|*Chemotherapy, Adjuvant[MESH]|Antineoplastic Agents/*therapeutic use[MESH]|Carcinoma, Hepatocellular/*drug therapy/surgery[MESH]|Controlled Clinical Trials as Topic[MESH]|Drug Therapy, Combination[MESH]|Humans[MESH]|Liver Neoplasms/*drug therapy/surgery[MESH]|Neoplasm Recurrence, Local/etiology[MESH]|Postoperative Care[MESH]|Preoperative Care[MESH]|Randomized Controlled Trials as Topic[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |