Local Treatment of Hepatocellular Carcinoma with Oligometastases: A Systematic Review and Meta-Analysis

Abstract

Oligometastasis is defined as a malignancy disease characterized by a limited number of metastatic foci (3-5). In studies of lung cancer and prostate cancer, local treatment such as radiotherapy or surgery increased the prognosis of oligometastases. The efficacy of local treatment for oligometastasis of hepatocellular carcinoma is not well known. This meta-analysis reports that active local treatment of oligometastases in hepatocellular carcinoma significantly increased survival rates and improved survival outcomes. Abstract: Although recent studies have shown favorable results after local treatment for oligometastases, the clinical decision of applying local treatment for oligometastatic hepatocellular carcinoma (HCC) remains controversial. This meta-analysis aimed to investigate the benefits of local treatment for HCC oligometastases. Pubmed, Embase, Medline, and the Cochrane library were searched for studies until 1 May 2022. Clinical studies involving at least five cases of HCC oligometsatases treated with local modalities were included. The primary endpoint was overall survival (OS). The benefit of local treatment was assessed as the pooled odds ratio (OR) among comparative series, and the pooled OS percentile was calculated from all studies including patients treated with local treatment. Complications of grade >= 3 were assessed subjectively. A total of 10 studies involving 527 patients were included. Radiotherapy and radiofrequency ablation (RFA) were mainly performed (six and five studies) as local modalities treating oligometastases. Pooled OR of comparative series favored the use of local treatment (4.664, 95% confidence interval [CI]: 2.595-8.380, p < 0.001, I-2: similar to 0.0%). Including all cohorts with patients who underwent local treatment, pooled rates of 1-year OS were 71.8% (95% CI: 59.0-81.9; I-2 = 81.5%), and pooled 2-year OS were 43.3% (95% CI: 29.1-59.6; I-2 = 85.4%). Except for temporal or pre-existing toxicities, grade <= 3 complications were reported less than 10% in most studies, although common toxicities include pneumothorax and hematologic deficiency after RFA and radiotherapy, respectively. Grade 5 toxicity has not yet been reported. This systematic review supports the application of local treatment for treating HCC oligometastases.