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

BMC Cancer

Research Article

Kang Wang¹  Nan Li¹  Xu-Biao Wei¹  Shu-Qun Cheng¹  Cheng-Qian Zhong¹  Yu-Qiang Cheng¹  Xiu-Ping Zhang¹  Yu-Zhen Gao²  Han Wang³ 

[1] Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, 200433, Shanghai, China;Department of Laboratory Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China;Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China;

关键词: Hepatic resection;    Transarterial chemoembolization;    Hepatocellular carcinoma;    Portal vein tumor thrombus;   

DOI  :  10.1186/s12885-017-3895-z

 received in 2017-04-21, accepted in 2017-12-08,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017