The efficacy of surgery and transarterial chemoembolization for hepatocellular carcinoma patients with portal vein tumor thrombus

Background: According to Barcelona Clinic Liver Cancer (BCLC) Group, hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) are defined as BCLC stage C who are recommend with sorafenib. Several studies have found survival benefits followed by hepatectomy and transarterial chemoembolization (TACE) other than recommend therapies. In order to discuss this controversy, we aim to find out which therapy is better for these patients. Methods: From 2010 to 2011, 170 HCC patients were enrolled in this study (surgery group, n=85; TACE group, n=85). Databases were searched to conduct meta-analysis to evaluate the efficacy of surgery and TACE in patients with PVTT. Results: In our study, patients underwent hepatectomy had significantly better survival than patients underwent TACE [mean survival (MS): 17.28 months vs. 10.28 months, P=0.001]. Patients with PVTT type I (MS: 18.97 months) had significantly longer survival than patients with PVTT type II (MS: 11.71 months, P=0.010) and type III (MS: 6.98 months, P<0.001). The difference between patients with PVTT type II or III was also significant (P<0.001). Meta-analysis results also showed that patients in surgery group had better 1-year survival [risk ratio (RR)=1.23, 95% confidence interval (CI) 1.09 to 1.39], 2-year survival (RR=1.86, 95% CI 1.54 to 2.24) and 3-year survival (RR=2.09, 95% CI 1.62 to 2.71) than patients in TACE group. Conclusion: The study demonstrated that hepatectomy has potential to improve survival and is safe for HCC patients with PVTT. However, further well-designed controlled trials needs to confirm this effect.