However, a significant heterogeneity in survival among RCTs remai

However, a significant heterogeneity in survival among RCTs remained even after stratifying patients and study features, and heterogeneity in the survival rates persisted even in the stratum of high-quality studies, implying that this was not explained by study validity alone. Therefore, the evaluation of the methodological quality did not seem to influence the variability of the assessed outcome, because of the mean high quality of the studies (75% of these RCTs were high-quality studies). Heterogeneity of these rates among RCTs may reflect

both inclusion of patients with different stages of disease and variability in the molecular Palbociclib nmr characteristics and biological behavior of the tumor, which are not included in any of the currently available staging systems. In our analysis, when studies were separated according to the BCLC stage, the 1-year survival was much higher in RCTs including only BCLC B or C patients (34%) than in those also including BCLC D patients (11%). This provides further evidence that the BCLC staging system has a good discriminative capacity for prognosticating survival not only in patients with early HCC41 but also in those with intermediate/advanced HCC. However, data on direct selleck BCLC stage were

lacking in several trials, and caution must be exercised when interpreting results from subgroup exploratory analyses. We found by meta-regression analysis that ECOG performance status and portal vein thrombosis are robust predictors of death in untreated patients as reported by Tandon and Garcia-Tsao42 in a recent systematic review of 72 studies on prognostic indicators in HCC. These

CHIR-99021 purchase two individual parameters, both included in the BCLC classification, may explain in large part why this staging system provides accurate information on prognosis in the setting of HCC. A remarkable difference in survival was found between occidental (North American and European) and oriental (Asia-Pacific) studies. The high prevalence of HBV-related liver disease found in Asia-Pacific countries may account for the different survival observed between oriental and occidental studies in which a high prevalence of HCV-related liver disease was observed. However, the potential role of HBV as a prognostic factor disappears when Asian-Pacific location of the studies and HBV-related disease were both included in a multivariate model. The survival differences between occidental and Asian studies may be explained by differences in the distribution of other risk and prognostic factors. In fact, the worse survival observed in the Asia-Pacific study36 could be explained by the higher prevalence of patients in advanced stage than in the SHARP study.

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