Narrow-margin hepatectomy combined with external beam radiotherapy in patients with hepatocellular carcinoma: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en mars 2025 (8 études, 1 057 patients), cette méta-analyse évalue l'efficacité d'une hépatectomie à marge étroite en combinaison ou non avec une radiothérapie externe pour un carcinome hépatocellulaire
Background: There is still controversy regarding which adjuvant treatment should be used after hepatectomy to reduce recurrence and prolong survival. This study aims to compare the short-term and long-term outcomes between narrow margin hepatectomy combined with external beam radiotherapy (EBRT) and narrow margin hepatectomy alone in hepatocellular carcinoma (HCC) patients.
Patients and methods: We conducted comprehensive searches in PubMed, Embase, the Cochrane Library, and Web of Science from database inception to March 2025. Eligible studies were those comparing narrow-margin hepatectomy with EBRT versus narrow-margin hepatectomy alone in HCC patients and reporting recurrence or survival. Meta-analysis was subsequently performed to pool data and assess therapeutic efficacy.
Results: The analysis included eight studies with 1,057 patients, of whom 461 underwent narrow-margin hepatectomy with EBRT and 596 underwent narrow-margin hepatectomy alone. For disease-free survival (DFS), The pooled HRs (hazard ratios) was 0.6(95% CI: 0.49–0.74). The pooled ORs (odds ratios) for 1-, 3-, and 5-year outcomes were 2.47 (95% confidence interval [CI]: 1.75–3.49), 2.00 (95% CI: 1.52–2.63), and 2.20 (95% CI: 1.63–2.96), respectively. For overall survival (OS), the pooled HRs was 0.68(95% CI: 0.52–0.88). The pooled ORs for 1-, 3-, and 5-year outcomes were 3.86 (95% CI: 1.88–7.96), 1.97 (95% CI: 1.42–2.74), and 1.73 (95% CI: 1.29–2.33), respectively. In terms of recurrence, the OR for intrahepatic recurrence was 0.57 (95% CI: 0.42–0.78) in the EBRT combination group, while the OR for extrahepatic recurrence was 0.60 (95% CI: 0.37–0.96). Subgroup analyses showed that the combined treatment provided a significant advantage in all but two subgroup, which demonstrated a non-significant trend. Sensitivity analyses confirmed that these pooled results were robust. A total of 17 cases (4.42%) of grade 3 adverse events (AEs) were reported, with no grade ≥ 4 AEs observed.
Conclusion: This study indicates that narrow-margin hepatectomy combined with adjuvant EBRT can reduce tumor recurrence and prolong survival in HCC patients. However, additional high-quality RCTs evaluating this combined strategy are required for validation.
BMC Cancer , article en libre accès, 2026