Preoperative transarterial chemoembolization (TACE) plus liver resection versus upfront liver resection for large hepatocellular carcinoma (=5?cm): a systematic review and meta-analysis

被引:0
|
作者
Chan, Kai Siang [1 ]
Tay, Wei Xuan [2 ]
Cheo, Feng Yi [2 ]
Shelat, Vishal G. [1 ,2 ,3 ]
机构
[1] Tan Tock Seng Hosp, Dept Gen Surg, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
[2] Natl Univ Singapore, Yong Loo Lin Sch Med, Singapore, Singapore
[3] Nanyang Technol Univ, Lee Kong Chian Sch Med, Singapore, Singapore
关键词
Hepatocellular carcinoma; lipiodol; liver cancer; neoadjuvant; transarterial chemoembolization; transcatheter chemoembolization; TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION; PROGNOSIS; CANCER; CM; EFFICACY; INJURY; SAFETY; ALPHA;
D O I
10.1080/00015458.2023.2256539
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundHepatocellular carcinoma (HCC) accounts for majority of primary liver cancer. Use of preoperative neoadjuvant transarterial chemoembolization (PN-TACE) may result in tumor shrinkage and improve resectability. This study aims to summarize the outcomes of PN-TACE versus upfront liver resection (Up-LR) in large HCC (& GE;5 cm).MethodsPubMed, Embase, The Cochrane Library, and Scopus were systematically searched till September 2022 for studies comparing PN-TACE versus Up-LR. The primary study outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Our secondary outcomes were postoperative morbidity and mortality.ResultsThere were 12 studies with 15 data sets including 3960 patients (PN-TACE n = 2447, Up-LR n = 1513). Majority (89.5%, n = 1250/1397) of patients had Child's A liver cirrhosis. Incidence of Child's B cirrhosis was higher in PN-TACE compared to Up-LR (Odds ratio (OR) 1.69, 95% CI: 1.18, 2.41, p = 0.004). Pooled hazard ratio (HR) for OS showed no significant difference between PN-TACE and Up-LR (HR 0.87, 95% CI: 0.64, 1.18, p = 0.37), but DFS was superior in PN-TACE (HR 0.79, 95% CI: 0.63, 0.99, p = 0.04). Subgroup analysis based on study design failed to show any significant effect in randomized controlled trials (n = 2/15 data sets). However, operating time (mean difference (MD) 31.94 min, 95% CI: 2.42, 61.45, p = 0.03) and blood loss (MD 190.93 ml, 95% CI: 10.22, 317.65, p = 0.04) were higher in PN-TACE. Intrahepatic and extrahepatic recurrence, post-operative morbidity and in-hospital mortality were comparable between PN-TACE and Up-LR.ConclusionIn retrospective studies, PN-TACE resulted in superior DFS compared to Up-LR. However, this may be confounded by selection bias.
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页码:601 / 617
页数:17
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