Comparison of Partial Hepatectomy and Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

<b><i>Introduction:</i></b> According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, transarterial chemoembolization (TACE) is recommended in patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B), whereas partial hepatectomy (PH) is restricted to early stage A. Expanding the indication for PH to intermediate stage remains debated. <b><i>Objective:</i></b> This meta-analysis aimed to analyze short- and long-term outcomes of PH compared to TACE in patients with intermediate-stage HCC. <b><i>Methods:</i></b> A meta-analysis was conducted according to PRISMA guidelines. Trials comparing PH with TACE in patients with intermediate-stage HCC were selected. Only patients of BCLC-B stage were included in the analyses. Primary endpoint was overall survival (OS) and secondary endpoint was 90-day postprocedural mortality. Random-effects models were used to analyze time ratios (TRs). <b><i>Results:</i></b> Seven eligible trials were analyzed, including 1,730 BCLC-B patients undergoing PH (<i>n</i> = 750) or TACE (<i>n</i> = 980). Comparison of OS between PH and TACE determined a pooled TR of 1.91 (95% CI 1.24–2.94; <i>p</i> < 0.001). Survival rates at 1-, 3-, and 5-year were 85, 60, and 42% after PH, compared to 73, 60, and 20% after TACE (<i>p</i> < 0.001). There was no difference in postprocedural mortality between PH and TACE with rates of 3.7 and 3.4%, respectively (TR 0.95; 95% CI 0.17–5.50; <i>p</i> = 0.879). <b><i>Conclusions:</i></b> In patients with intermediate HCC, PH was associated with increased long-term survival compared to TACE, with comparable postprocedural mortality. These results suggest considering PH as treatment option in intermediate HCC and highlight the urgent need to refine the selection of patients with BCLC-B stage who may benefit from PH.

The Combination of Age, International Standardized Ratio, Albumin and γ-Glutamyl Transpeptidase (AIAG), Tumor Size and Alpha Fetoprotein (AFP) Stage as the Prognostic Model for Hepatitis B-Related Hepatocellular Carcinoma

“…In clinical practice, the BCLC staging was an important parameter for developing treatment strategy and evaluating the prognosis of HCC patients. 23 , 24 More recently, the BCLC staging has also been used for further prognostication of HCC patients undergoing radiation therapy, radiofrequency ablation, 25 , 26 transarterial chemoembolization, 27 and even of HCC patients without treatment. 28 , 29 However, BCLC staging mainly focuses on tumor characteristics that cannot be modified, and is not related to cirrhotic status.…”

Rethinking the Barcelona clinic liver cancer guidelines: Intermediate stage and Child-Pugh B patients are suitable for surgery?

“…In a recent study, Tada et al [ 57 ] concluded that LR is superior to TACE in BCLC-B patients with HCC with three nodules or less in Child-Pugh A cirrhosis. The superiority of surgery over TACE in class B BCLC patients was confirmed in four meta-analyses[ 58 - 61 ], one clinical trial[ 28 ], and one large observational study[ 62 ].…”

Surveillance Strategy for Barcelona Clinic Liver Cancer B Hepatocellular Carcinoma Achieving Complete Response: An Individualized Risk-Based Machine Learning Study

“…Nevertheless, recent advances in technology and appropriate patient selection have gradually reduced the morbidity and mortality of radical treatments, which have been considered for BBHCC patients with promising results in terms of postoperative outcomes (Day et al, 2016;Chen et al, 2017). For example, Labgaa I et al systematically analyzed 1,730 BBHCC patients and found that compared with TACE, surgery improved long-term survival; postoperative mortality was equivalent (Labgaa et al, 2020). In our previous study, ablation-TACE combination therapy had a better clinical efficacy than TACE monotherapy for BBHCC (Chen et al, 2017;Zhang et al, 2018).…”