Survival benefit of hepatic resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Abstract

BackgroundNo consensus treatment has been reached for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Hepatic resection (HR) and transarterial chemoembolization (TACE) have been recommended as effective options, but which is better remains unclear. This meta-analysis is to compare the effectiveness of HR and TACE for HCC with PVTT patients.MethodsThe PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched for comparing HR and TACE treating PVTT.ResultsTwelve retrospective studies with 3129 patients were included. A meta-analysis of 11 studies suggested that the 1-, 2-, 3-, and 5-year overall survival (OS) rates (OR = 0.48, 95% CI = 0.41–0.57, I2 = 37%, P < 0.00001; OR = 0.21, 95% CI = 0.12–0.38, I2 = 43%, P < 0.00001; OR = 0.35, 95% CI = 0.28–0.44, I2 = 53%, P < 0.00001; OR = 0.28, 95% CI = 0.14–0.54, I2 = 72%, P = 0.0001, respectively) favored HR over TACE. In a subgroup analysis, HR had better 1-, 2-,3, 5-year OS for type I PVTT (OR = 0.33, 95% CI = 0.17–0.64, I2 = 20%, P = 0.001; OR = 0.32, 95% CI = 0.16–0.63, I2 = 0%, P = 0.001; OR = 0.18, 95% CI = 0.09–0.36, I2 = 0%, P < 0.00001; OR = 0.07, 95% CI = 0.01–0.32, I2 = 0%, P = 0.0006, respectively) and better 1-, 3-, and 5-year OS for type II PVTT (OR = 0.37, 95% CI = 0.20–0.70, I2 = 59%, P = 0.002; OR = 0.22, 95% CI = 0.13–0.39, I2 = 0%, P < 0.00001; OR = 0.16; 95% CI = 0.03–0.91; I2 = 51%, P = 0.04, respectively). There was no difference in 1-, 3-, or 5-year OS between HR and TACE for type III PVTT (OR = 0.86, 95% CI = 0.61–1.21, I2 = 0%, P = 0.39; OR = 0.83, 95% CI = 0.42–1.64, I2 = 0%, P = 0.59; OR = 0.59, 95% CI = 0.06–-6.04, I2 = 65%, P = 0.66, respectively).ConclusionsHR may lead to longer OS for some selected HCC patients with PVTT than TACE, especially for type I or II PVTT, with less difference being observed for type III or IV PVTT.

<p>Safety and Efficacy of Camrelizumab Combined with Apatinib for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Multicenter Retrospective Study</p>

“…6,7 In China, the incidences of PVTT have been reported to range from 44% to 62.2%. 8,9 The treatment of HCC patients with PVTT is based on the patients' liver function, the stage of hepatic lesion, and the extent of PVTT. For example, transcatheter arterial chemoembolization (TACE) is recommended as the primary treatment for PVTT patients with Child-Pugh A liver function, while its efficacy in these patients still remained unsatisfactory.…”

Resection vs. Sorafenib for Hepatocellular Carcinoma With Macroscopic Vascular Invasion: A Real World, Propensity Score Matched Analytic Study

“…Before new targeted drugs such as lenvatinib and immune checkpoint inhibitors were available, the first-line of treatment for HCC patients with MVI recommended by the Barcelona guideline was systemic therapy with sorafenib (3) and had a median overall survival (mOS) ranging from 5.6 to 8.1 months (4,5). However, in the Asia-Pacific region, some patients with MVI, especially those without extrahepatic metastases, could still benefit from survival through resection, with mOS ranging from 8.9 to 33 months (6)(7)(8)(9)(10)(11). Therefore, the optimal choice between the two therapies for HCC patients with MVI was controversal.…”

An Eastern Hepatobiliary Surgery Hospital/Portal Vein Tumor Thrombus Scoring System as an Aid to Decision Making on Hepatectomy for Hepatocellular Carcinoma Patients With Portal Vein Tumor Thrombus

“…However, heterogeneities in HCC patients with PVTT, which include genetic background, tumor burden, clinicopathological characteristics, and hepatic function (Child‐Pugh A or selected B), explain why not all patients would benefit from sorafenib. Also, in selected HCC patients with PVTT limited to a first‐order branch of the MPV or above, R0 LR can result in a cure . Thus, this selected subgroup of patients needs to be identified.…”