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Review
. 2017 Mar 21;8(12):20418-20427.
doi: 10.18632/oncotarget.14668.

The best strategy for HCC patients at each BCLC stage: a network meta-analysis of observational studies

Lei Chang  1 , Yitao Wang  1 , Jibo Zhang  2 , Tao Guo  1
Affiliations
Review

The best strategy for HCC patients at each BCLC stage: a network meta-analysis of observational studies

Lei Chang et al. Oncotarget. .

Abstract

Background and aims: Currently, the Barcelona Clinic Liver Cancer staging system remains huge controversies in the management of hepatocellular carcinoma. To determine the best therapeutic strategy for patients at each stage, we conducted a network meta-analysis and aimed to provide a new treatment concept.

Materials and methods: PubMed, Embase and Cochrane Library database were searched for observational studies up to August 31, 2016. We extracted data on overall survival rate from studies that compared various strategies for use with patients at different stages. Network meta-analysis was conducted by evaluating the different overall survival rate of each stage. Cumulative probability value was utilized to rank the strategies under examination. A node-splitting model was employed to assess consistency and inconsistency.

Results: A total of 198 observational studies were included in the network meta-analysis with a focus on Stages 0-D. By comparing the overall survival rate of each stage, the results revealed that liver transplantation and liver transplantation plus transcatheter arterial chemoembolization were the best options for patients with Stages 0 and A. The applications of surgical resection plus transcatheter arterial chemoembolization and surgical resection plus sorafenib were the best strategies for Stages B and C. For Stage D, whole net connection could not be established, but intra-arterial infusion chemotherapy and liver transplantation could be potential primary options.

Conclusions: The existing therapeutic flowchart needs to be updated. Potential best strategies relating to all stages were identified and should be used as references for clinical treatments.

Keywords: BCLC stages; hepatocellular carcinoma; network meta-analysis.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Flow diagram of the process of (and the reasons for) including and excluding studies for this meta-analysis
Figure 2
Figure 2. Network connections of included studies for BCLC Stage 0
A. Data for 1-year overall survival rate. B. Data for 3-year overall survival rate. C. Data for 5-year overall survival rate.
Figure 3
Figure 3. Network connections of included studies for BCLC Stage A
A. Data for 1-year overall survival rate. B. Data for 3-year overall survival rate. C. Data for 5-year overall survival rate.
Figure 4
Figure 4. Network connections of included studies for BCLC Stages B, C, and D
A. Data for 1-year (left panel) and 3-year (right panel) overall survival rates for BCLC Stage B. B. Data for 1-year overall survival rate for BCLC Stage C. C. Data for 1-year overall survival rate for BCLC Stage D.
Figure 5
Figure 5
Probability of different therapy strategies as measured by the included outcomes for BCLC A. Stage 0; B. Stage A; C. Stage B; D. Stage C; E. Stage D. OS: overall survival.
Figure 6
Figure 6. Previous version of and updates to BCLC Therapeutic Flowchart
See this image and copyright information in PMC

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