Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

Abstract

Background: Guidelines recommend that hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and/or hepatic vein tumor thrombosis (HVTT) should undergo systemic therapy.However, recent data suggest that surgical resection may be beneficial in selected cases, but outcomes are heterogenous. We aimed to estimate pooled overall survival (OS), recurrence free survival (RFS) and complication rates in HCC patients with macrovascular invasion (MVI) following surgical resection.Methods: In this systematic review and meta-analysis, two investigators independently searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020, without language restrictions, for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.Results: We screened 8,598 articles and included 40 studies involving 8,218 patients. Among all patients with MVI, the pooled median OS was 14.39 months [95% confidence interval (

Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis

“…Systemic chemotherapy, EBRT, or a combination of both are preferred. 32 , 33 A recent study concluded that combined TACE and radiation therapy (RT), rather than systemic treatment alone, may be considered as a first-line treatment option for patients with HCC and macrovascular invasion. 34 A previous randomized controlled trial and systematic review reported that neoadjuvant RT provided significantly better post-operative survival outcomes than surgery alone in patients with resectable HCC and PVTT.…”

Meta‐analysis: Chemoprevention of hepatocellular carcinoma with statins, aspirin and metformin

“…Hepatocellular carcinoma (HCC) is the third leading cause of cancer‐related death worldwide 1,2 . Patients with HCC have a 5‐year survival of less than 20% overall 3–7 . The poor prognosis of HCC, in general, has led to increased interest in HCC prevention.…”

“…1,2 Patients with HCC have a 5-year survival of less than 20% overall. [3][4][5][6][7] The poor prognosis of HCC, in general, has led to increased interest in HCC prevention. Emerging data suggest that the use of statins, aspirin and metformin may be chemoprotective against HCC.…”

Hepatocellular carcinoma with macrovascular invasion: need a personalized medicine for this complicated event

“…Recently, Huang et al ( 8 ) presented a meta-analysis reporting clinical outcomes of surgical resection for HCC with MVI including 40 studies involving 8,218 patients. This study may have a significant clinical impact because there has never been such a sizable study before.…”

“…According to the results of the meta-analysis, they suggested that surgical resection may be a viable alternative option in the setting of segmental or 2 nd order PVTT. Whereas, they suggested that invasive surgery should be avoided in HCC patients with 1 st order or main PVTT, given the poor OS outcomes ( 8 ).…”