Liver resection versus transarterial chemoembolization for the initial treatment of Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma
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Current evidence supporting the efficacy of transarterial chemoembolization (TACE) in Barcelona Clinic Liver Cancer (BCLC)-B hepatocellular carcinoma (HCC) is controversial. The aim of this systematic review was to compare the benefits of liver resection (LR) versus TACE in BCLC-B HCC.
We conducted a comprehensive literature review of the EMBASE, PubMed, Google Scholar, and Chinese Biomedical Literature databases for retrospective or prospective studies evaluating the efficacy of LR and TACE for the treatment of BCLC-B HCC.
Eleven studies incorporating 3366 patients were included in this analysis. 1-year (RR 0.52 95% CI 0.43–0.63, p < 0.001; I2 = 59%, p = 0.006), 3-year (RR 0.63 95% CI 0.59–0.67, p < 0.001; I2 = 16%, p = 0.29), and 5-year (RR 0.69 95% CI 0.63–0.75, p < 0.001; I2 = 56%, p = 0.021) OS were significantly improved in BCLC-B HCC patients that underwent LR compared to those that underwent TACE. Child–Pugh A liver disease (B vs. A) (HR 1.45 95% CI 1.17–1.79, p < 0.001; I2 = 0%, p = 0.49) and AFP levels (> 400 vs. ≤ 400 ng/ml) (HR 1.36 95% CI 1.09–1.71, p = 0.007; I2 = 90%, p = 0.001) were associated with improved OS.
Liver resection had significant survival benefits over TACE in selected BCLC-B HCC patients in comparison to TACE. However, LR was associated with a significantly increased incidence of treatment-related mortality and infection compared to TACE.
KeywordsHepatocellular carcinoma Transarterial chemoembolization BCLC Resection Intermediate stage
This study was sponsored by the Science and Technology Department of Sichuan Province of China (2017SZ0014) to LZY.
Compliance with ethical standards
Conflict of interest
Biao Yang, Bo Zheng, MaoNan Yang, Zhu Zeng, FangYun Yang, Ji Pu, ChunLin Li, ZhengYin Liao declare that there are no competing interests.
Ethics approval and consent to participate
This cohort study was approved by the Local Ethics Committee of West China Hospital, Sichuan University.
- 16.Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748Google Scholar
- 18.Liu X, Li L, Xiang BD, et al. Efficacy of hepatic resection and transarterial chemoembolization for stage B hepatocellular carcinoma in the barcelona clinic liver cancer classification. Chin J Clin Oncol 2012;39:1225–1228Google Scholar
- 19.Guo Z, Xiang B, Jiang J, et al. Survival comparison between hepatic resection and transarterial chemoembolization for matched patients with large hepatocellular carcinoma. Chin J Gen Surg 2015;30:290–293Google Scholar