Treatment of hepatocellular carcinoma with macroscopic vascular invasion: A systematic review and network meta-analysis

• Published in: Transplantation reviews (Philadelphia, Pa.) Pa.), 2023-07, Vol.37 (3), p.100763-100763, Article 100763
• Main Authors: Tustumi, Francisco, Coelho, Fabricio Ferreira, de Paiva Magalhães, Daniel, Júnior, Sérgio Silveira, Jeismann, Vagner Birk, Fonseca, Gilton Marques, Kruger, Jaime Arthur Pirola, D'Albuquerque, Luiz Augusto Carneiro, Herman, Paulo
• Format: Article
• Language: English
• Subjects: Carcinoma, Hepatocellular - surgery; Chemoembolization, Therapeutic; Drug therapy; Hepatectomy; Hepatocellular carcinoma; Humans; Liver Neoplasms - surgery; Network Meta-Analysis; Survival analysis; Therapeutic chemoembolization; Treatment Outcome
• ISSN: 0955-470X; 1557-9816
• DOI: 10.1016/j.trre.2023.100763

This study aimed to evaluate the outcomes of different treatments for patients with hepatocellular carcinoma (HCC) and macroscopic vascular invasion. A systematic review and meta-analysis of comparative studies was performed to evaluate various treatment modalities for HCC with macroscopic vascular invasion, including liver resection (LR), liver transplantation (LT), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiotherapy (RT), radiofrequency ablation (RFA), and antineoplastic systemic therapy (AnST). After applying the selection criteria, 31 studies were included. The surgical resection (SR) group (including LR and LT) had a similar mortality rate to the non-surgical resection (NS) group (RD = −0.01; 95% CI -0.05 to 0.03). The SR group had a higher rate of complications (RD = 0.06; 95% CI 0.00 to 0.12) but a higher 3-year overall survival (OS) rate than the NS group (RD = 0.12; 95% CI 0.05 to 0.20). The network analysis revealed that the overall survival was lower in the AnST group. LT and LR had similar survival benefits. The meta-regression suggested that SR has a greater impact on the survival of patients with impaired liver function. Most likely, LT has a significant impact on long-term survival and consequently would be a better option for HCC with macroscopic vascular invasion in patients with impaired liver function. LT and LR offer a higher chance of long-term survival than NS alternatives, although LR and LR are associated with a higher risk of procedure-related complications. •There is no consensus on the treatment for HCC with macroscopic vascular invasion.•This study evaluated the treatment options for HCC with major vascular invasion.•Surgical resection is associated with a higher risk of complications.•Surgical resection offers a higher chance for survival than non-surgical alternatives.