Is hepatic resection better than transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis?

Catrine Ibrahim, Natalia Parra, Francisco Igor MacEdo, Danny Yakoub

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The management of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR) and transarterial chemoembolization (TACE). Methods: Comprehensive online databases search was performed. Comparative studies measuring survival in HCC patients with PVTT undergoing HR versus TACE were included. Pooled risk ratios with corresponding 95% confidence intervals (CI) were calculated for overall survival (OS) at 1, 3, and 5 years. Study quality and heterogeneity was assessed. Results: Six studies comprising 1,320 patients were included. HR was done in 526 (39.8%) patients and TACE in 794 (60.2%) patients. Meta-analysis of all included studies showed improved OS in HR compared to TACE patients at 1-year (OR: 1.49, 95% CI: 1.16-1.92, P=0.002), 3-year (OR: 3.33, 95% CI: 1.55-7.12, P=0.002) and 5-year (OR: 3.91, 95% CI: 1.42-10.77, P=0.008). Survival benefit conferred by HR was 7-33 months. This benefit was mostly noted in tumors with PVTT types I and II and those with single lesions. Age, ECOG status, and STROBE score did not contribute to differences in survival. Conclusions: Long-term survival outcomes of HCC with PVTT are superior in patients undergoing hepatectomy compared to TACE. Further experience with randomized clinical trials may be warranted to confirm these findings.

Original languageEnglish (US)
Pages (from-to)1064-1072
Number of pages9
JournalJournal of Gastrointestinal Oncology
Volume10
Issue number6
DOIs
StatePublished - Dec 1 2019

Keywords

  • Hepatocellular carcinoma (HCC)
  • Portal vein tumor thrombosis (PVTT)
  • Resection
  • Trans-arterial chemoembolization

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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