A systematic review comparing outcomes of surgical resection and non-surgical treatments for patients with hepatocellular carcinoma and portal vein tumor thrombus

Background: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is very poor. According to most HCC guidelines, sorafenib, transarterial chemo-embolization (TACE) or other non-surgical treatments are recommended as the first-line therapy for these patients. However, selected patients with HCC and PVTT can undergo surgical resection (SR). The aim of this meta-analysis was to compare the outcomes of SR with Non-SR for such patients. Methods: The PubMed, Embase, Medline and Cochrane library were searched for studies which compared SR with Non-SR for HCC and PVTT published before December 2017. Results: 4810 patients from 7 studies who were enrolled in this meta-analysis were divided into the SR group (n = 2 344, 49%) and the Non-SR group (n = 2 476, 51%). The pooled hazard ratios (HRs) for the 1-, 3- and 5-year OS rates of the SR group when compared with the Non-SR group, were 0.57 (95% CI 0.48-0.67, P < 0.001), 0.66 (95% CI 0.56-0.77, P < 0.001) and 0.68 (95% CI 0.57-0.81, P < 0.001), respectively. On subgroup analysis, the pooled HRs for the 1-, 3-and 5-year OS rates of the SR group when compared with the TACE group, were 0.62 (95% CI 0.54-0.71, P < 0.001), 0.74 (95% CI 0.66-0.83, P < 0.001) and 0.78 (95% CI 0.70-0.87, P < 0.001), respectively. Conclusion: This meta-analysis showed SR resulted in better OS than TACE, or other Non-SR treatments, for patients with HCC and PVTT. SR should be considered in selected patients with resectable HCC and PVTT.