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lüll Review article: Overview of medical treatments in unresectable hepatocellular carcinoma--an impossible meta-analysis?Mathurin P; Rixe O; Carbonell N; Bernard B; Cluzel P; Bellin MF; Khayat D; Opolon P; Poynard TAliment Pharmacol Ther 1998[Feb]; 12 (2): 111-26BACKGROUND: 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 = 0.9-6.8). 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.|Administration, Cutaneous[MESH]|Antineoplastic Agents/administration & dosage/*therapeutic use[MESH]|Carcinoma, Hepatocellular/*drug therapy/therapy[MESH]|Doxorubicin/therapeutic use[MESH]|Ethanol/therapeutic use[MESH]|Fluorouracil/therapeutic use[MESH]|Humans[MESH]|Interferons/therapeutic use[MESH]|Liver Neoplasms/*drug therapy/therapy[MESH]|Odds Ratio[MESH]|Randomized Controlled Trials as Topic[MESH]|Survival Analysis[MESH]|Tamoxifen/therapeutic use[MESH] |