Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):1-13. 10.14701/ahbps.23-090.

The impact of waiting time and delayed treatment on the outcomes of patients with hepatocellular carcinoma: A systematic review and meta-analysis

• Cheo FY
• Lim CHF
• Chan KS
• Shelat VG

• KMID: 2553360
• DOI: http://doi.org/10.14701/ahbps.23-090

Abstract

Hepatocellular carcinoma (HCC) is the sixth most diagnosed cancer worldwide. Healthcare resource constraints may predispose treatment delays. We aim to review existing literature on whether delayed treatment results in worse outcomes in HCC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till December 2022. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included post-treatment mortality, readmission rates, and complications. Fourteen studies with a total of 135,389 patients (delayed n = 25,516, no delay n = 109,873) were included. Age, incidence of male patients, Child–Pugh B cirrhosis, and Barcelona Clinic Liver Cancer Stage 0/A HCC were comparable between delayed and no delay groups. Tumor size was significantly smaller in delayed versus no delay group (mean difference, –0.70 cm; 95% confidence interval [CI]: –1.14, 0.26; p = 0.002). More patients received radiofrequency ablation in delayed versus no delay group (OR, 1.22; 95% CI: 1.16, 1.27; p < 0.0001). OS was comparable between delayed and no delay in HCC treatment (hazard ratio [HR], 1.13; 95% CI: 0.99, 1.29; p = 0.07). Comparable DFS between delayed and no delay groups (HR, 0.99; 95% CI: 0.75, 1.30; p = 0.95) was observed. Subgroup analysis of studies that defined treatment delay as > 90 days showed comparable OS in the delayed group (HR, 1.04; 95% CI: 0.93, 1.16; p = 0.51). OS and DFS for delayed treatment were non-inferior compared to no delay, but might be due to better tumor biology/smaller tumor size in the delayed group.

Keyword

Hepatocellular carcinoma; Liver cancer; Treatment delay; Time to treatment

Figure

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  Fig. 1 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flowchart for study selection.

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  Fig. 2 Comparison of (A) overall survival and (B) disease-free survival between delayed treatment and no delay in patients with hepatocellular carcinoma. BCLC, Barcelona Liver Cancer Clinic; CI, confidence interval; SE, standard error.

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  Fig. 3 Subgroup analysis comparing overall survival between delayed treatment and no delay in patients with hepatocellular carcinoma with (A) time-to-treatment cut-off defined as 90 days, and (B) received liver resection only. BCLC, Barcelona Liver Cancer Clinic; CI, confidence interval; SE, standard error.

Reference

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