An analysis of the evidence underpinning the surgical treatment of hepatocellular carcinoma.

person Imad Radi Medical College of Georgia, Augusta, GA info_outline Imad Radi, Samantha Zhan-Moodie, Luke Scanlan, Viktoriya Sapkalova, Nerella Resheek, Mehul Mehra, Steven Colquhoun, Danny Yakoub

Authors person Imad Radi Medical College of Georgia, Augusta, GA info_outline Imad Radi, Samantha Zhan-Moodie, Luke Scanlan, Viktoriya Sapkalova, Nerella Resheek, Mehul Mehra, Steven Colquhoun, Danny Yakoub Organizations Medical College of Georgia, Augusta, GA Abstract Disclosures Research Funding No funding sources reported Background: The American Association for the Study of Liver Diseases (AASLD) and National Comprehensive Cancer Network (NCCN) guidelines on Hepatocellular Carcinoma (HCC) surgery are based on evidence from many different systematic reviews (SRs) and meta-analyses (MAs). Quality of these studies needs to be standardized. Methods: SRs and MAs cited in AASLD and NCCN HCC (2023) surgery guidelines were collated by two independent reviewers. An independent third reviewer acted as tie-breaker when necessary. The standardized assessment tools, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) were used to evaluate the quality of these studies. Quality of studies was determined based on adherence to items of the checklist. The PRISMA and AMSTAR checklists consist of 41 and 16 items, respectively. Results: Overall, 13 studies were identified, 9 from AASLD guidelines and 4 from the NCCN. Studies were published between 2007 and 2023, with 38% being published in the last 5 years. Studies had an average of 23,829 patients. Many of the studies (71%) reported use of the PRISMA checklist, but no studies cited the AMSTAR checklist. Studies had an average adherence of 68% to the PRISMA checklist, with a median of 76% (range 17-88%). 23% of studies adhered to less than half of the PRISMA checklist. Looking at the AMSTAR checklist, studies had an average adherence of 51%, with a median of 56% (range 4-72%). 31% of studies adhered to less than half the AMSTAR checklist. Adherence was lowest in items involving availability and accessibility of protocols, assessing risk of bias, and transparency of protocols. Additionally, no papers reported funding sources of their reviewed articles. Conclusions: There is significant room for improvement in MAs and SRs about HCC surgical management. Many quoted studies needed more rigorous methodology and quality control for conducting and reporting. It is important to fully investigate and communicate the biases present in MAs and SRs to readers. PRISMA and AMSTAR checklists can be used when reviewing and selecting evidence for future guideline development to offer the most complete and transparent understanding of data presented.