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Makary MS, Ramsell S, Miller E, Beal EW, Dowell JD. Hepatocellular carcinoma locoregional therapies: Outcomes and future horizons. World J Gastroenterol 2021; 27:7462-7479. [PMID: 34887643 PMCID: PMC8613749 DOI: 10.3748/wjg.v27.i43.7462] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/09/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and has an overall five-year survival rate of less than twenty percent. For patients with unresectable disease, evolving liver-directed locoregional therapies provide efficacious treatment across the spectrum of disease stages and via a variety of catheter-directed and percutaneous techniques. Goals of locoregional therapies in HCC may include curative intent in early-stage disease, bridging or downstaging to surgical resection or transplantation for early or intermediate-stage disease, and local disease control and palliation in advanced-stage disease. This review explores the outcomes of chemoembolization, bland embolization, radioembolization, and percutaneous ablative therapies. Attention is also given to prognostic factors related to each of the respective techniques, as well as future directions of locoregional therapies for HCC.
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Affiliation(s)
- Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Stuart Ramsell
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Eric Miller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Joshua D Dowell
- Department of Radiology, Northwest Radiology, St. Vincent Health, Indianapolis, IN 46260, United States
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Grégory J, Créquit P, Vilgrain V, Boutron I, Ronot M. Published trials of TACE for HCC are often not registered and subject to outcome reporting bias. JHEP Rep 2021; 3:100196. [PMID: 33490934 PMCID: PMC7804986 DOI: 10.1016/j.jhepr.2020.100196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background & Aims In 2005, the registration of all randomised controlled trials (RCTs) before enrolment of participants became a condition for publication by the International Committee of Medical Journal Editors to increase transparency in trial reporting. Among RCTs on transarterial chemoembolisation (TACE) for the treatment of hepatocellular carcinoma (HCC) published after 2007, we assess the proportion that were registered and compare registered primary outcomes (PO) with those reported in publications to determine whether primary outcome reporting bias favoured significant outcomes. Methods We searched MEDLINE and EMBASE for reports of RCTs evaluating TACE for HCC treatment between 1 September 2007 and 31 March 2018. Registration and publication information for each included RCT was compared using a standardised data extraction form. Results Thirteen out of 53 (25%) included RCTs were correctly registered (i.e. before the starting date of the RCT), 14 (26%) were registered after the RCT starting date, and 26 (49%) were not registered. Six out of 14 of the retrospectively registered RCTs (43%) were registered after their completion date. The PO was clearly reported in the published article of all registered RCTs, whereas the report was not clear in 8/26 (31%) of the non-registered RCTs (p = 0.01). Among registered RCTs, 8/27 (30%) had major discrepancies between registered and published PO. The influence of these discrepancies could be assessed in 6 of them and was shown to statistically favour significant results in 2. Conclusions Registration and outcome reporting in RCTs on TACE for HCC are often inadequate. Registration should be reinforced because it is a key to transparency. Lay summary Trial registration is fundamental to our understanding and interpretation of results, as it provides information on all relevant clinical trials (to place the results in a broader context), and on the details of their associated protocols (to ensure that the scientific plan is followed). Once a randomised controlled trial (RCT) is completed, the trial results are usually publicly shared via scientific articles that are expected to thoroughly and objectively report them. This study shows that half of the RCTs evaluating transarterial chemoembolisation for hepatocellular carcinoma were not registered, and identified major discrepancies between registered and published primary outcome favouring significant results. Trial registration is fundamental to our understanding and interpretation of results. Half of published randomised controlled trials evaluating transarterial chemoembolisation for HCC were not registered. When registered, one-third had major discrepancies between the registered and published primary outcomes. Selective outcome reporting favouring the trial results was observed in 7% of published reports.
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Affiliation(s)
- Jules Grégory
- INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Hôpital Hôtel Dieu, Paris, France.,Université de Paris, Paris, France.,Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Perrine Créquit
- INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Hôpital Hôtel Dieu, Paris, France.,Direction of Clinical Research, Foch Hospital, Suresnes, France
| | - Valérie Vilgrain
- Université de Paris, Paris, France.,Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, Assistance Publique des Hôpitaux de Paris, Clichy, France.,Laboratory of Imaging Biomarkers, INSERM U1149, Centre for Research on Inflammation, Paris, France
| | - Isabelle Boutron
- INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Hôpital Hôtel Dieu, Paris, France.,Université de Paris, Paris, France
| | - Maxime Ronot
- Université de Paris, Paris, France.,Department of Radiology, Beaujon Hospital, Paris Nord Val de Seine Hospitals, Assistance Publique des Hôpitaux de Paris, Clichy, France.,Laboratory of Imaging Biomarkers, INSERM U1149, Centre for Research on Inflammation, Paris, France
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