Comparison of Partial Hepatectomy and Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Details

Serval ID
serval:BIB_D5A02BBDF5DB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Comparison of Partial Hepatectomy and Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.
Journal
Liver cancer
Author(s)
Labgaa I., Taffé P., Martin D., Clerc D., Schwartz M., Kokudo N., Denys A., Halkic N., Demartines N., Melloul E.
ISSN
2235-1795 (Print)
ISSN-L
1664-5553
Publication state
Published
Issued date
04/2020
Peer-reviewed
Oui
Volume
9
Number
2
Pages
138-147
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, transarterial chemoembolization (TACE) is recommended in patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B), whereas partial hepatectomy (PH) is restricted to early stage A. Expanding the indication for PH to intermediate stage remains debated.
This meta-analysis aimed to analyze short- and long-term outcomes of PH compared to TACE in patients with intermediate-stage HCC.
A meta-analysis was conducted according to PRISMA guidelines. Trials comparing PH with TACE in patients with intermediate-stage HCC were selected. Only patients of BCLC-B stage were included in the analyses. Primary endpoint was overall survival (OS) and secondary endpoint was 90-day postprocedural mortality. Random-effects models were used to analyze time ratios (TRs).
Seven eligible trials were analyzed, including 1,730 BCLC-B patients undergoing PH (n = 750) or TACE (n = 980). Comparison of OS between PH and TACE determined a pooled TR of 1.91 (95% CI 1.24-2.94; p < 0.001). Survival rates at 1-, 3-, and 5-year were 85, 60, and 42% after PH, compared to 73, 60, and 20% after TACE (p < 0.001). There was no difference in postprocedural mortality between PH and TACE with rates of 3.7 and 3.4%, respectively (TR 0.95; 95% CI 0.17-5.50; p = 0.879).
In patients with intermediate HCC, PH was associated with increased long-term survival compared to TACE, with comparable postprocedural mortality. These results suggest considering PH as treatment option in intermediate HCC and highlight the urgent need to refine the selection of patients with BCLC-B stage who may benefit from PH.
Keywords
Barcelona Clinic Liver Cancer, Liver cancer, Loco-regional therapy, Resection, Surgery, Transarterial chemoembolization
Pubmed
Web of science
Open Access
Yes
Create date
28/05/2020 10:01
Last modification date
18/12/2020 6:26
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