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Liver resection versus transarterial chemoembolization for the initial treatment of Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

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Abstract

Aims

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

This study was sponsored by the Science and Technology Department of Sichuan Province of China (2017SZ0014) to LZY.

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Authors and Affiliations

  1. Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Biao Yang, Zhu Zeng, FangYun Yang, ChunLin Li & ZhengYin Liao

  2. Department of Interventional Radiology, High-Tech Hospital, Zigong, People’s Republic of China

    Bo Zheng & Ji Pu

  3. Department of Oncology, LeShan Tradition Medicine Hospital, Leshan, People’s Republic of China

    MaoNan Yang

Authors
  1. Biao Yang
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  2. Bo Zheng
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  3. MaoNan Yang
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  4. Zhu Zeng
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  5. FangYun Yang
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  6. Ji Pu
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  7. ChunLin Li
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  8. ZhengYin Liao
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Corresponding authors

Correspondence to Biao Yang or ZhengYin Liao.

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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.

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Yang, B., Zheng, B., Yang, M. et al. Liver resection versus transarterial chemoembolization for the initial treatment of Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma. Hepatol Int 12, 417–428 (2018). https://doi.org/10.1007/s12072-018-9888-4

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  • DOI: https://doi.org/10.1007/s12072-018-9888-4

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