Hepatic Resection after Initial Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone for the Treatment of Hepatocellular Carcinoma: A Meta-analysis of Observational Studies

Tang, Yulong; Qi, Xingshun; Guo, Xiaozhong

doi:10.7314/apjcp.2015.16.17.7871

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…Consistent with previously studies, our analysis demonstrates that an add‐on resection or ablation after initial TACE significantly extended the survival time and increased the percentage of patients who reached a 3‐year survival time . This suggests that add‐on resection/ablation works synergistically with TACE.…”

Section: Discussionsupporting

confidence: 90%

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Chen

Jian

et al. 2019

Cancer Medicine

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Objective Transarterial chemoembolization (TACE) is recommended to treat intermediate/advanced stage of hepatocellular carcinoma (HCC). However, the overall survival among initially TACE‐treated patients varies significantly. The clinical characterization of long‐term survival following TACE remains uncertain. We sought to identify clinical parameters and treatment requirements for long‐term survival among patients with hepatitis B‐related HCC who were initially treated with TACE. Materials and Methods The included patients with HCC were admitted to our cancer center between December 2009 and May 2015. Patients who survived for >3 years were compared with those who died within 3 years. The clinical and laboratory findings that were associated with the survival were also analyzed. Results One in six (17.9%) patients with HCC in this cohort survived for > 3 years after TACE. Body mass index (BMI) ≥ 23kg/m 2 , aspartate aminotransferase levels ≤ 40 U/L, an activated partial thromboplastin time ≤ 34 seconds, α‐fetoprotein (AFP) levels ≤ 25 ng/mL, antiviral therapy, tumor size ≤ 8 cm, solitary nodule, and the absence of vascular invasion were independently favorably associated with a 3‐year survival. An absence of vascular invasion was the only independent factor associated with 3‐year survival in patients who received resection and/or ablation after TACE. Conclusion In this cohort, a 3‐year survival was associated with BMI, antivirus treatment, tumor status, hepatic function, and AFP level. Distant metastasis did not negatively impact the long‐term survival among patients with hepatitis B‐related HCC initially treated with TACE. Vascular invasion was the single impediment to long‐term survival in patients who received add‐on resection and/or ablation after TACE.

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Section: Discussionsupporting

confidence: 90%

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Chen

Jian

et al. 2019

Cancer Medicine

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“…This may offset the relatively shorter PFS resulting from the W-W strategy. Previous studies have reported a significantly improved OS in patients who underwent hepatic resection after initial TACE compared to those who received TACE alone 28 . However, these studies aimed to investigate the survival benefits of hepatic resection following TACE for the treatment of HCC.…”

Section: Discussionmentioning

confidence: 95%

Watch-and-wait strategy vs. resection in patients with radiologic complete response after conversion therapy for initially unresectable hepatocellular carcinoma: a propensity score-matching comparative study

Li,

Wang,

et al. 2024

International Journal of Surgery

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Background: The optimal subsequent management for patients with initially unresectable hepatocellular carcinoma (uHCC) who have achieved complete response (CR) following conversion therapy remains unclear. This study aims to evaluate the feasibility and outcomes of the watch-and-wait (W-W) strategy versus surgical resection (SR) for these patients. Materials and Methods: This retrospective study reviewed patients with initially uHCC who underwent conversion therapy employing transarterial therapies combined with or without systemic therapies. Radiologic CR (rCR), clinical CR (cCR), and pathologic CR (pCR) were evaluated. Overall survival (OS) and progression-free survival (PFS) were compared between the W-W and SR groups. Results: Among 1880 patients with uHCC who underwent conversion therapy, 207 (11.0%) achieved rCR. Finally, we enrolled 149 patients meeting the inclusion criteria, including 74 receiving W-W strategy and 75 undergoing SR. Among the 149 patients with rCR, the W-W group demonstrated comparable 3-year OS rates to the SR group (80.9% vs 83.1%, P=0.77), but demonstrated inferior PFS rates (14.4% vs 46.5%, P=0.002). These results remained consistent after propensity score matching. For the 57 patients who achieved cCR, the W-W group exhibited comparable 3-year OS (88.1% vs 87.9%, P=0.89) and PFS rates (27.8% vs 40.8%, P=0.34) compared to SR group. Among the 75 patients in the SR group, 31 (41.3%) achieved pCR and 44 (58.7%) reached non-pCR. When compared with patients with pCR, those who achieved rCR in the W-W group showed comparable OS but inferior PFS rates. Moreover, patients who achieved rCR in the W-W group displayed both comparable OS and PFS rates to those with non-pCR. Conclusion: The W-W strategy offered comparable survival outcomes to surgical resection in patients with initially uHCC who achieved rCR or cCR after conversion therapy. For these patients, the W-W strategy could be offered as an alternative treatment option.

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“…According to the BCLC stage system, TACE is the standard therapy for BCLC stage B (intermediate HCC) patients and plays an important role in replacing other therapies that are not applicable regarding early or advanced HCC[ 31 ]. Many meta-analyses have demonstrated that pre-operative TACE has no significant effect on improving the survival of patients with resectable HCC[ 32 - 34 ], but none of them mentioned the effect on unresectable HCC.…”

Section: Resultsmentioning

confidence: 99%

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

Zhang

Luo

et al. 2018

WJCC

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AIMTo review the conversion therapy for initially unresectable hepatocellular carcinoma (HCC) patients and the suitable timing for subsequent salvage surgery.METHODSA PubMed search was undertaken from 1987 to 2017 to identify articles using the keywords including “unresectable” “hepatocellular carcinoma”, ”hepatectomy”, ”conversion therapy”, “resection”, “salvage surgery” and “downstaging”. Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction.RESULTSLiver volume measurements [future liver remnant (FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests (scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing complications, morbidity or mortality. The requirements for performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR (sFLR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehensively evaluated.CONCLUSIONConversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subsequent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.

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Hepatic Resection after Initial Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone for the Treatment of Hepatocellular Carcinoma: A Meta-analysis of Observational Studies

Cited by 8 publications

References 22 publications

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Clinical conditions and treatment requirements for long‐term survival among hepatitis B‐related hepatocellular carcinoma initially treated with chemoembolization

Watch-and-wait strategy vs. resection in patients with radiologic complete response after conversion therapy for initially unresectable hepatocellular carcinoma: a propensity score-matching comparative study

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

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