Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis

Abstract

BackgroundAlthough transarterial chemoembolization (TACE) has been used extensively for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), no consensus has been reached and an evidence base for practice is lacking. This meta-analysis evaluated the efficacy and safety of TACE for treatment of HCC with PVTT.MethodsOvid Medline, EMBASE, Web of Knowledge, and Cochrane library databases were searched up to August 2012 for controlled trials assessing TACE in patients with PVTT. Data concerning the study design, characteristics of trials, and outcomes were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using random effects models.ResultsEight controlled trials involving 1601 HCC patients were included. TACE significantly improved the 6-month (HR, 0.41; 95% CI: 0.32–0.53; z, 6.28; p = 0.000) and 1-year (HR, 0.44; 95% CI: 0.34–0.57; z, 6.22; p = 0.000) overall survival of patients with PVTT compared with conservative treatment. Subgroup analyses showed that TACE was significantly effective in HCC patients whether with main portal vein (MPV) obstruction or with segmental PVTT. Fatal complications were rare, even in patients with MPV obstruction. Temporary liver decompensation and postembolization syndrome occurred frequently. However, they could be treated successfully with conservative treatment.ConclusionsTACE, as a safe treatment, has potential for incurring a survival benefit for advanced HCC with PVTT, even with MPV obstruction. Further large randomized controlled trials may be needed to confirm this result.

The problem of current classications of the hepatocellular carcinoma. Analytical review

“…Расширение показаний для хирургического лечения ГЦР нуждается в активном изучении [28,29,30]. В некоторых неоперабельных случаях ГЦР может быть эффективной хемоэмболизацией [31,32]. Стадия С первоначально выделена на группе лишь из 102 пациентов [33].…”

Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

“…In both the Asian Pacific Association for the Study of the Liver (APASL) guidelines and HKLC scoring system, TACE is a possible treatment option for patients with HCC and limited portal vein thrombosis [8,10] ( Figure 6). A number of Asian studies and a meta-analysis of eight trials (including five retrospective studies) have shown a survival benefit vs untreated control arms, on condition that the portal vein thrombosis is limited [37][38][39][40] . However, it is not possible to validate the use of TACE in this indication on the basis of these results.…”

Intrahepatic biloma following transcatheter arterial chemoembolization for hepatocellular carcinoma: Incidence, imaging features and management

“…Hepatitis B and C and alcohol abuse are major risk factors for HCC. Although local ablation techniques and multikinase inhibitors, such as radiofrequency ablation and sorafenib, are increasingly prevalent, transcatheter arterial chemoembolization (TACE) remains one of the standard treatments for patients with intermediate-and advanced-stage HCC (1)(2)(3). Several randomized controlled studies have revealed that TACE improves survival and controls the symptoms of HCC (4)(5)(6)(7)(8).…”