Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

Abstract

Background and Aim A debate exists over whether using preoperative transarterial chemoembolization for patients with hepatocellular carcinoma before liver transplantation. Numerous studies have been investigating on this, but there is still no unanimous conclusion about the effect of preoperative transarterial chemoembolization. We conducted the meta‐analysis of all available studies to systematically evaluate the influence of preoperative transarterial chemoembolization on liver transplant. Methods A systematic search was performed by two authors (Si TF. and Guan RY.) through PubMed, Embase, Cochrane, and Science Citation Index Expanded, combined with Manual Retrieval and Cited Reference Search. The searching cut‐off date was 2016/07/31, and all the data obtained were statistically analyzed using Review Manager version 5.1 software (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2011) recommended by Cochrane Collaboration. Results The study showed that there was no difference between the experimental group and the control group on perioperative mortality (RR = 1.10, 95% confidence interval (CI) = [0.49–2.48], P = 0.82) or biliary complications (RR = 0.96, 95%CI = [0.66–1.39], P = 0.83). Preoperative transarterial chemoembolization had no obvious effect on improving overall survival (HR = 1.05, 95%CI = [0.65–1.72], P = 0. 83) but would result in a higher rate of vascular complications (RR = 2.01, 95%CI = [1.23–3.27], P = 0.005) and a reduction of disease free survival (HR = 1.66, 95%CI = [1.02–2.70], P = 0.04). Subgroup analysis also revealed that patients from transarterial chemoembolization group in Asia had a much lower overall survival rate (HR = 2.65, 95%CI = [1.49–4.71], P = 0.0009) compared with the control group. Conclusions Considering the possible adverse impacts on liver transplantation and the variation in sensitivity to transarterial chemoembolization, clinicians should be more cautious when considering transarterial chemoembolization as the bridging therapy for patients in the waiting list.

<p>LncRNA ASB16-AS1 Promotes Growth And Invasion Of Hepatocellular Carcinoma Through Regulating miR-1827/FZD4 Axis And Activating Wnt/β-Catenin Pathway</p>

“…3 The five-year survival rate in HCC patients is only about 30%. 4 Hence, it is urgently required to investigate the in-depth mechanisms of HCC development.…”

2018 Korean Liver Cancer Association–National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma

“…The effects of neoadjuvant treatments on survival after liver transplantation are difficult to assess. Many studies reported similar survival rates between treated and untreated individuals prior to transplantation (253254255256257258259). Patients who received locoregional treatments before liver transplantation in Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients were more likely to achieve longer survival than those who did not, particularly those with longer waiting periods before transplantation (260).…”

<p>LINC01296 promotes proliferation, migration, and invasion of HCC cells by targeting miR-122-5P and modulating EMT activity</p>

“…Hepatocellular carcinoma (HCC) is a major health problem worldwide 1,2. It affects more than 500,000 people worldwide every year,3 with a 5-year survival rate of 30% 4. The poor prognosis is mainly attributed to a high rate of recurrence and metastasis 5…”