Hepatocellular Carcinoma in Liver Cirrhosis: Surgical Resection versus Transarterial Chemoembolization-A Meta-Analysis

Abstract

We compare the value of TACE to liver resection for patients with BCLC stage A and B HCC. For patients with HCC in cirrhosis LT is the treatment of choice. TACE represents the current standard for unresectable BCLC stage B patients not eligible for LT. Recently liver resection for HCC and significant cirrhosis has become increasingly popular. A systematic search of the literature and meta-analysis was conducted to identify studies, reporting short- and long-term results of hepatic resection versus TACE for HCC treatment. The data were analyzed regarding the odds for 30-day mortality and hazard ratio for overall-survival. 12 studies comparing short- and long-term outcome of HR versus TACE for HCC were identified. Peri-interventional mortality and overall survival were investigated. Peri-interventional mortality was higher for surgical resection (n.s.), and overall-survival was significantly better for surgically treated patients at one year (P = 0.002) and 3 years (P ≤ 0.00001). The hazard ratio of overall-survival for all twelve studies was 0.70 (P = 0.0001) and significantly in favor of surgical treatment. Although large RCTs are missing and the available data are limited and not homogeneous a reappraisal of the current treatment guidelines should be considered based on the superior long-term outcome for surgically treated patients.

Figure 1

((a), (b)) Strategy for staging and treatment assignment in patients diagnosed with HCC according to the BCLC proposal [12].

Figure 2

PRISMA flowchart diagram of search strategy.

Figure 3

30-day mortality.

Figure 4

Forest plot illustrating subgroup analysis of short- and long-term overall-survival comparing hepatic resection to TACE. The center of each square represents the hazard ratio for individual trial and each horizontal line represents its 95% CI. The size of the box is directly related to the “weighting” of the study. The center of the diamond represents the pooled hazard ratio and the width represents its 95% CI. For each subgroup (1, 3, and 5 years), the sum of the statistics is represented by the first three diamonds. The last diamond illustrates the overall result of the meta-analysis.

Figure 5

Funnel plot at 3-year overall-survival depicting the distribution of hazard ratios for the 12 studies included in the meta-analysis. The outer dashed lines indicate the triangular region within which 95% of studies are expected to lie in the absence of reporting biases and heterogeneity. The solid vertical lines correspond to no intervention effect.