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

BMC Gastroenterology

Zheng-Gang Ren¹  Bo-Heng Zhang²  Xin Yin¹  Lan Zhang¹  Xiao-Ying Xie¹  Tong-Chun Xue¹ 

[1] Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, P.R. China;Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, P.R. China

关键词: Meta-analysis;    Embolus;    Portal vein;    Hepatocellular carcinoma;    Chemoembolization;   

Others  :  858098
DOI  :  10.1186/1471-230X-13-60

 received in 2012-11-25, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Background

Although 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.

Methods

Ovid 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.

Results

Eight 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.

Conclusions

TACE, 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.

【 授权许可】

   
2013 Xue et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin 2011, 61:69-90.
• [2]Forner A, Reig ME, de Lope CR, Bruix J: Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 2010, 30:61-74.
• [3]Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A: Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008, 359:378-390.
• [4]Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS: Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009, 10:25-34.
• [5]Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003, 37:429-442.
• [6]Luo J, Guo RP, Lai ECH, Zhang YJ, Lau WY, Chen MS, Shi M: unresectable hepatocellular carcinoma with portal vein tumor thrombosis: A prospective comparative study. Ann Surg Oncol 2011, 18:413-420.
• [7]Niu ZJ, Ma YL, Kang P, Ou SQ, Meng ZB, Li ZK, Qi F, Zhao C: Transarterial chemoembolization compared with conservative treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus: using a new classification. Med Oncol 2012, 29:2992-2997.
• [8]Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR: Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007, 8:16. BioMed Central Full Text
• [9]Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY: The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study. Cancer 1997, 11:2087-2094.
• [10]Chung GE, Lee JH, Kim HY, Hwang SY, Kim JS, Chung JW, Yoon JH, Lee HS, Kim YJ: Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011, 258:627-634.
• [11]Kim KM, Kim JH, Park IS, Ko GY, Yoon HK, Sung KB, Lim YS, Lee HC, Chung YH, Lee YS, Suh DJ: Reappraisal of repeated transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein invasion. J Gastroenterol Hepatol 2009, 24:806-814.
• [12]Zhou Q, Wang Y, Zhou X, Peng B, Yang J, Liang L, Li J: Prognostic analysis for treatment modalities in hepatocellular carcinomas with portal vein tumor thrombi. Asian Pac J Cancer Prev 2011, 12:2847-2850.
• [13]Kim JH, Yoon HK, Kim SY, Kim KM, Ko GY, Gwon DI, Sung KB: Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis. Aliment Pharmacol Ther 2009, 29:1291-1298.
• [14]Peng ZW, Guo RP, Zhang YJ, Lin XJ, Chen MS, Lau WY: Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus. Cancer 2012, 118:4725-4736.
• [15]Han KH, Kudo M, Ye SL, Choi JY, Poon RT, Seong J, Park JW, Ichida T, Chung JW, Chow P, Cheng AL: Asian consensus workshop report: expert consensus guideline for the management of intermediate and advanced hepatocellular carcinoma in Asia. Oncology 2011, 81(Suppl 1):158-164.
• [16]Sacco R, Bargellini I, Bertini M, Bozzi E, Romano A, Petruzzi P, Tumino E, Ginanni B, Federici G, Cioni R: Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2011, 22:1545-1552.
• [17]Pinter M, Hucke F, Graziadei I, Vogel W, Maieron A, Konigsberg R, Stauber R, Grunberger B, Muller C, Kolblinger C: Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology 2012, 263:590-599.
• [18]Hoffmann K, Glimm H, Radeleff B, Richter G, Heining C, Schenkel I, Zahlten-Hinguranage A, Schirrmacher P, Schmidt J, Buchler MW: Prospective, randomized, double-blind, multi-center, Phase III clinical study on transarterial chemoembolization (TACE) combined with Sorafenib versus TACE plus placebo in patients with hepatocellular cancer before liver transplantation - HeiLivCa [ISRCTN24081794]. BMC Cancer 2008, 8:349. BioMed Central Full Text
• [19]Sansonno D, Lauletta G, Russi S, Conteduca V, Sansonno L, Dammacco F: Transarterial chemoembolization plus sorafenib: a sequential therapeutic scheme for HCV-related intermediate-stage hepatocellular carcinoma: a randomized clinical trial. Oncologist 2012, 17:359-366.