Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Xingshun Qi,Lei Liu,Xiaozhong Guo,Chunping Su,Hongyu Li,Diya Wang

doi:10.18632/oncotarget.5426

Abstract

The prognosis of hepatocellular carcinoma (HCC) treated with hepatic resection may be improved by the adjunctive use of transarterial chemoembolization (TACE). This study aimed to systematically compare the outcomes between hepatic resection with and without TACE groups. All relevant randomized controlled trials (RCTs) and non-RCTs were searched by the PubMed, EMBASE, and Cochrane Library databases. Overall survival (OS) and disease-free survival (DFS) were two major outcomes. Meta-analyses were performed according to the timing of TACE (pre- or post-operative TACE). Subgroup analyses were also performed. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were calculated. Overall, 55 papers were included (14 RCTs and 41 non-RCTs). Overall meta-analyses demonstrated that OS and DFS were statistically similar between hepatic resection with and without pre-operative TACE groups (HR = 1.01, 95%CI = 0.87-1.19, P = 0.87; HR = 0.91, 95%CI = 0.82-1.01, P = 0.07). Subgroup analyses of RCTs or non-RCTs showed that OS and DFS remained statistically similar between hepatic resection with and without pre-operative TACE groups. Subgroup analysis of incomplete or no tumor necrosis showed that OS was worse in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. By contrast, subgroup analysis of complete tumor necrosis showed that DFS was better in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group.Overall meta-analyses demonstrated that OS and DFS were better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group (HR = 0.85, 95%CI = 0.72-1.00, P = 0.06; HR = 0.83, 95%CI = 0.73-0.94, P = 0.004). Subgroup analyses of RCTs, vascular invasion, or large HCC showed that OS and DFS remained better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group. By contrast, subgroup analyses of non-RCTs, no vascular invasion, or small HCC showed that OS and DFS were statistically similar between the two groups. Post-operative TACE, rather than pre-operative TACE, may be considered as an adjunctive treatment option for HCC treated with hepatic resection.

Highlights

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies in the world [1,2]
Post-operative transarterial chemoembolization (TACE), rather than pre-operative TACE, may be considered as an adjunctive treatment option for hepatocellular carcinoma (HCC) treated with hepatic resection
One paper was excluded, because the separate data in hepatic resection combined with TACE group could not be obtained [15]; four papers were excluded, because the survival and recurrence data were not provided [16,17,18,19]; and two papers were excluded, because they compared the outcomes of prophylactic versus therapeutic TACE for recurrent HCC [20,21]

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies in the world [1,2]. Hepatic resection is a curative treatment option for HCC [3,4]. The current practice guidelines recommend that hepatic resection should be employed for the treatment of early HCC with single nodule and normal liver function but without clinically significant portal hypertension [5]. On the other hand, accumulated evidence suggests that the indications for hepatic resection may be further extended outside the early stage of HCC [8,9,10]. More and more patients are considered as the candidates for hepatic resection due to the improvement of diagnostic methods, early surveillance, and surgical skills [11]. The prognosis of hepatocellular carcinoma (HCC) treated with hepatic resection may be improved by the adjunctive use of transarterial chemoembolization (TACE). This study aimed to systematically compare the outcomes between hepatic resection with and without TACE groups

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Conclusion