Efficacy and safety of preoperative transarterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Objective

The aim of the study was to compare preoperative transcatheter arterial chemotherapy (TACE) plus liver resection (LR) with liver resection (LR) alone for hepatocellular carcinoma (HCC).

Materials and methods

PubMed, Embase, Cochrane library, web of science and China National Knowledge Infrastructure (CNKI) were searched from their initiation until 24 August 2021. Eligible languages were English and Chinese. This study includes only RCT and cohort studies. The primary outcome was the prognostic factors including overall survival rate (OS), disease-free survival (DFS), recurrence-free survival (RFS), and we also research the operative time, intraoperative blood loss, and postoperative complication.

Results

Twenty-nine trials (2 RCTs and 27 cohorts) were included, containing a total of 22023 patients, compared with hepatic resection, preoperative TACE plus LR shows the benefit of RFS (Hazard Ratio (HR)=0.80, 95%CI = [0.73–0.88], p < .001), and the combined therapy was associated with a higher OS for patients with HCC in Barcelona Clinic Liver Cancer (BCLC) B stage (HR = 0.76, 95%CI = [0.60–0.96], p = .024). In terms of safety, combination therapy is related to less intraoperative blood loss (Weighted Mean Difference (WMD)=-11.17, 95%CI = [-21.79 to −0.54], p = .039); and there’s no statistical significance in postoperative complication (Risk Ratio (RR)=0.99, 95%CI= [0.90–1.08], p = 0.771) and operative time (WMD = 7.57, 95%CI = [-5.07 to 20.20], p = .240).

Conclusion

TACE prior to surgery should be recommended as a routine treatment for HCC patients, especially BCLC B stage HCC, in view of its benefits for RFS and OS. Large, multicenter, and blinded randomized trials should be performed to confirm these findings.

Keywords:

• Hepatocellular carcinoma
• meta-analysis
• transcatheter arterial chemoembolization
• hepatectomy

Ethical approval

All analyses were based on previous published studies, thus no ethical approval and patient consent are required.

Author contributions

Mi SZ and Nie Y wrote the main manuscript and fully participated in all analyses. Xie CM contributed to the study concept and design. All authors participated in literature search, data extraction, and quality assessment. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

Certificate of China Postdoctoral Science Foundation [Grant No. 2018M641848]; Certificate of Heilongjiang Postdoctoral Financial Assistance [Grant No. LBH-Z18118]; The Foundation of the First Affiliated Hospital of Harbin Medical University [Grant No. 201713020]; The Heilongjiang Province General Undergraduate Colleges and Universities Young Innovative Talents Training Plan [Grant No. UNPYSCT2017065].