Survival benefits from adjuvant transcatheter arterial chemoembolization in patients undergoing liver resection for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Background: Although adjuvant transcatheter arterial chemoembolization (TACE) has been used to prevent recurrence after surgery in patients with hepatocellular carcinoma (HCC), the survival benefits from adjuvant TACE remain controversial. We sought to systematically evaluate the data on the effectiveness of adjuvant TACE for HCC, as well as identify patient populations that might benefit from adjuvant TACE. Methods: The PubMed, Embase, Medline and Cochrane library were systematically searched for studies published before July 2019 that compared adjuvant TACE versus surgery alone for HCC. The study endpoints were overall survival (OS) and disease-free survival (DFS). Patients with large HCC (⩾5 cm), multinodular HCC, microvascular invasion (MVI), or portal vein tumor thrombosis (PVTT) were analyzed in subgroup analyses. Results: Twenty-four studies with 6977 patients were included in the analytic cohort. The pooled analysis demonstrated that adjuvant TACE was associated with a better OS and DFS [hazard ratio (HR): 0.67 and 0.67, both p < 0.01]. In subgroup analyses, pooled results revealed that adjuvant TACE was associated with an improved OS and DFS in patients with multinodular HCC (HR: 0.79 and 0.31, both p < 0.01), MVI (HR: 0.62 and 0.67, both p < 0.01), or PVTT (HR: 0.49 and 0.58, both p < 0.01), but not among patients with large HCC (⩾5 cm). Conclusion: Postoperative adjuvant TACE may be effective to improve OS and DFS in patients with multinodular HCC, or HCC with MVI or PVTT. Future randomized controlled trials are needed to better define the benefit of adjuvant TACE in subset patients with HCC.

Portal Vein Tumor Thrombosis and Hepatocellular Carcinoma – The Changing Tides

“…167 A recent systemic review and meta-analysis containing 24 studies (RCT=9; NRCT=15; n=6,977) demonstrated that adjuvant TACE was associated with a better OS (based on n=6,573; RCT=6; NRCT=15) and better DFS (based on n=2,260; RCT=7; NRCT=6) than LR alone for HCC patients. 171 In subgroup analyses, the pooled results revealed that adjuvant TACE was associated with an improved OS and DFS in the patients with multinodular HCC (HR=0.79 and 0.31, both P<0.01), MVI (HR=0.62 and 0.67, both P<0.01), or PVTT (HR=0.49 and 0.58, both P<0.01), but not among the patients with large HCC 5 cm). Furthermore, the pooled analysis of all the studies demonstrated that patients who underwent surgery followed by adjuvant TACE had better 1-, 3-, and 5-year survival versus surgery alone.…”

“…The pooled HR for OS and DFS for all studies was in favor of adjuvant TACE after surgical resection. 171 A recent meta-analysis reported that sorafenib as adjuvant therapy after liver resection was associated with improved OS (hazard ratio=0.71, 95% CI=0.59-0.86; P<0.001), RFS (hazard ratio=0.68, 95% CI=0.54-0.86, P=0.001) and lower recurrence rate (pooled risk ratio=0.78, 95% CI=0.68-0.90, P<0.001) without unbearable side-effects. 172 The treatment options for the HCC patients with PVTT are listed in Figure 3.…”

“…The pooled HR for OS and DFS for all studies was in favor of adjuvant TACE after surgical resection. 171 …”

Development and validation of a novel online calculator for estimating survival benefit of adjuvant transcatheter arterial chemoembolization in patients undergoing surgery for hepatocellular carcinoma

“…Longterm prognosis after HCC resection is, however, still poor due to the high incidence of recurrence [3][4][5]. Transcatheter arterial chemoembolization (TACE) has been used in the postoperative setting as a means to decrease risk of recurrence and improve survival [6][7][8]. Whereas, in clinical practice, controversy persists relative to the role of adjuvant TACE for resected HCC [9][10][11].…”

The multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus

“…A retrospective study by propensity score matching, which included 464 patients with HCC and PVTT indicated that PA-TACE has better MST compared with surgery alone, especially for type II/III PVTT according to Cheng's classification (21). A subgroup analysis of systemic review and metaanalysis revealed that adjuvant TACE following surgery is associated with improved disease-free survival (DFS) and overall survival (OS) compared with surgery alone (22). However, subgroup analysis of the meta-analysis included only one RCT and one NRCT, allowing the adjuvant role of TACE to be controversial.…”