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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Author notes

    Authors and Affiliations

    1. Hepatopancreatobiliary Surgery Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, No. 52, Fu-Cheng-Lu Street, Beijing, 100142, People’s Republic of China

      Wei Liu, Yi Sun, Lei Zhang & Bao-Cai Xing

    2. Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, 149 Dalian Road, Zunyi, 563000, People’s Republic of China

      Jian-Guo Zhou

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    Correspondence to Bao-Cai Xing.

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    Wei Liu and Jian-Guo Zhou contributed equally to this work.

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    Fig. S2a

    Forrest plot summarizing the meta-analysis of gender (female vs. male) (TIF 39.2 kb)

    Fig. S2b

    Forrest plot summarizing the meta-analysis of age (>50 vs. ≤50 years) (TIF 35.7 kb)

    Fig. S2c

    Forrest plot summarizing the meta-analysis of Child-Pugh grade (B vs.A) (TIF 36.4 kb)

    Fig. S2d

    Forrest plot summarizing the meta-analysis of tumor number (>1 vs.1) (TIF 35.9 kb)

    Fig. S2e(1)

    Forrest plot summarizing the meta-analysis of tumor size (>5 vs.≤5 cm) (TIF 739 kb)

    Fig. S2e(2)

    Forrest plot summarizing the meta-analysis of tumor size (>10 vs. ≤10 cm) (TIF 34.5 kb)

    Fig. S2f

    Forrest plot summarizing the meta-analysis of AFP (>400 vs. ≤400 ng/ml) (TIF 37.0 kb)

    Fig. S2g

    Forrest plot summarizing the meta-analysis of HBV (+vs. −) (TIF 36.2 kb)

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    Liu, W., Zhou, JG., Sun, Y. et al. Hepatic Resection Improved the Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma in Asia: a Systematic Review and Meta-Analysis. J Gastrointest Surg 19, 1271–1280 (2015). https://doi.org/10.1007/s11605-015-2811-6

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