Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):243-251. 10.14701/ahbps.2020.24.3.243.

Value of surgical resection compared to transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein tumor thrombus: A meta-analysis of hazard ratios from five observational studies

• Kang K
• Song SK
• Chung CW
• Park Y

• KMID: 2505336
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.243

Abstract

Backgrounds/Aims
Although systemic therapy is recommended in advanced hepatocellular carcinoma (HCC), treatment options for advanced HCC with portal vein tumor thrombosis (PVTT) are debatable. Recent studies have recommended other treatments, such as surgical resection (SR) and transarterial chemoembolization (TACE). Therefore, we performed a meta-analysis of hazard ratio (HR) for overall survival (OS) between the two modalities using previous reports in order to compare the two treatment options.
Methods
A systematic review was performed on previously reported data that compared the survival benefits of SR and TACE in patients with advanced HCC with PVTT.Thereafter, the meta-analysis was performed to determine the cumulative HR between the two different treatment groups. We used the HR and 95% CI directly from the original data, when available; however, if these data were unavailable, reconstruction was performed with the secondary data from the original Kaplan-Meier survival curve.
Results
A total of seven studies were eligible; however, 2 were excluded from the meta-analysis. The remaining 5 studies that included 1422 patients (SR group=559, TACE group=863) were studied for the meta-analysis. The median OS was longer in the SR group (8.2-64 months in SR vs. 6.6-32 months in TACE), proving that SR offered survival benefits. Moreover, the HR for the OS in the TACE group was 1.64 (95% CI, 1.43-1.88) compared to SR group, depicting that TACE was a less favorable option compared to SR.
Conclusions
There is evidence that SR may be a better viable option for advanced HCC with PVTT.

Keyword

Hepatectomy; Hepatic resection; Portal vein invasion; Kaplan-Meier survival data

Figure

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  Fig. 1 Flow chart for study selection.

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  Fig. 2 Reconstructed Kaplan-Meier (KM) survival curves of 2 studies ((A) Ye et al.,25 (B) Zheng et al.12) to acquire hazard ratios secondarily from original KM data using the algorithm of Guyot et al.19

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  Fig. 3 Forest plot depicting hazard ratio of overall survival in transarterial chemoembolization compared to surgical resection using fixed-effect and random-effect models.

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  Fig. 4 Funnel plot depicting the publication bias in the included studies.

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