Hepatic Resection Improved the Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma in Asia: a Systematic Review and Meta-Analysis

Abstract

ObjectiveHepatic resection has been increasingly performed in patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the current evidence supporting its efficacy remains controversial. The aim of this systematic review was to investigate the long-term survival and safety of hepatic resection compared to transarterial chemoembolization (TACE) alone for BCLC stage B HCC. MethodsEligible trials that compared hepatic resection with TACE alone for intermediate HCC were identified from the Embase, PubMed, Web of Science, and Cochrane databases. The study outcomes included overall survival (OS) rate and treatment-related complication rate. Hazard ratios (HRs) with a 95 % confidence interval were used to measure the pooled effect according to a random-effects or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials statistically was evaluated using the χ2 and I2 tests. Sensitivity analyses were also performed. ResultsA total of 9 studies containing 4958 patients were included. The comparison between hepatic resection and TACE revealed a pooled HR for 3-year OS of 0.403 (95 % CI 0.364–0.446, p = 0.000; I2 = 0 %, p = 0.643) and a pooled HR for 5-year OS of 0.433 (95 % CI 0.394–0.475, p = 0.000; I2 = 0 %, p = 0.468). An AFP level >400 ng/ml and being HBV-positive were factors significantly correlated with overall survival. For treatment-related complications, the overall odds ratio (OR) for hepatic resection versus TACE was 0.990 (95 % CI 0.934–1.049; p = 0.728; I2 = 64.5 %, p = 0.060). ConclusionHepatic resection likely improved overall survival compared with TACE alone in BCLC stage B HCC patients, but did not increase the incidence of treatment-related complications. An AFP level >400 ng/ml and HBV positivity were significantly correlated with poor OS.