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Journal of Gastrointestinal Surgery

, Volume 19, Issue 7, pp 1271–1280 | Cite as

Hepatic Resection Improved the Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma in Asia: a Systematic Review and Meta-Analysis

  • Wei Liu
  • Jian-Guo Zhou
  • Yi Sun
  • Lei Zhang
  • Bao-Cai Xing
Original Article

Abstract

Objective

Hepatic resection has been increasingly performed in patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the current evidence supporting its efficacy remains controversial. The aim of this systematic review was to investigate the long-term survival and safety of hepatic resection compared to transarterial chemoembolization (TACE) alone for BCLC stage B HCC.

Methods

Eligible trials that compared hepatic resection with TACE alone for intermediate HCC were identified from the Embase, PubMed, Web of Science, and Cochrane databases. The study outcomes included overall survival (OS) rate and treatment-related complication rate. Hazard ratios (HRs) with a 95 % confidence interval were used to measure the pooled effect according to a random-effects or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials statistically was evaluated using the χ2 and I 2 tests. Sensitivity analyses were also performed.

Results

A total of 9 studies containing 4958 patients were included. The comparison between hepatic resection and TACE revealed a pooled HR for 3-year OS of 0.403 (95 % CI 0.364–0.446, p = 0.000; I 2 = 0 %, p = 0.643) and a pooled HR for 5-year OS of 0.433 (95 % CI 0.394–0.475, p = 0.000; I 2 = 0 %, p = 0.468). An AFP level >400 ng/ml and being HBV-positive were factors significantly correlated with overall survival. For treatment-related complications, the overall odds ratio (OR) for hepatic resection versus TACE was 0.990 (95 % CI 0.934–1.049; p = 0.728; I 2 = 64.5 %, p = 0.060).

Conclusion

Hepatic resection likely improved overall survival compared with TACE alone in BCLC stage B HCC patients, but did not increase the incidence of treatment-related complications. An AFP level >400 ng/ml and HBV positivity were significantly correlated with poor OS.

Keywords

Hepatocellular carcinoma TACE BCLC Resection 

Supplementary material

11605_2015_2811_MOESM1_ESM.tif (39 kb)
Fig. S2a Forrest plot summarizing the meta-analysis of gender (female vs. male) (TIF 39.2 kb)
11605_2015_2811_MOESM2_ESM.tif (36 kb)
Fig. S2b Forrest plot summarizing the meta-analysis of age (>50 vs. ≤50 years) (TIF 35.7 kb)
11605_2015_2811_MOESM3_ESM.tif (36 kb)
Fig. S2c Forrest plot summarizing the meta-analysis of Child-Pugh grade (B vs.A) (TIF 36.4 kb)
11605_2015_2811_MOESM4_ESM.tif (36 kb)
Fig. S2d Forrest plot summarizing the meta-analysis of tumor number (>1 vs.1) (TIF 35.9 kb)
11605_2015_2811_MOESM5_ESM.tif (740 kb)
Fig. S2e(1) Forrest plot summarizing the meta-analysis of tumor size (>5 vs.≤5 cm) (TIF 739 kb)
11605_2015_2811_MOESM6_ESM.tif (35 kb)
Fig. S2e(2) Forrest plot summarizing the meta-analysis of tumor size (>10 vs. ≤10 cm) (TIF 34.5 kb)
11605_2015_2811_MOESM7_ESM.tif (37 kb)
Fig. S2f Forrest plot summarizing the meta-analysis of AFP (>400 vs. ≤400 ng/ml) (TIF 37.0 kb)
11605_2015_2811_MOESM8_ESM.tif (36 kb)
Fig. S2g Forrest plot summarizing the meta-analysis of HBV (+vs. −) (TIF 36.2 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Wei Liu
    • 1
  • Jian-Guo Zhou
    • 2
  • Yi Sun
    • 1
  • Lei Zhang
    • 1
  • Bao-Cai Xing
    • 1
  1. 1.Hepatopancreatobiliary Surgery Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of EducationPeking University School of Oncology, Beijing Cancer Hospital and InstituteBeijingPeople’s Republic of China
  2. 2.Department of Oncology, Affiliated Hospital of Zunyi Medical UniversityZunyi Medical UniversityZunyiPeople’s Republic of China

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