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. 2022 Dec;11(6):848-860.
doi: 10.21037/hbsn-21-419.

Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

Daniel Q Huang #  1   2 , Andrew Tran #  3 , Eunice X Tan  1   2 , Sanjna N Nerurkar  2 , Readon Teh  1 , Margaret L P Teng  1 , Ee Jin Yeo  1   4 , Biyao Zou  5   6 , Connie Wong  7 , Carlos O Esquivel  8 , C Andrew Bonham  8 , Mindie H Nguyen  5   6
Affiliations

Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

Daniel Q Huang et al. Hepatobiliary Surg Nutr. 2022 Dec.

Abstract

Background: Guidelines recommend that hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and/or hepatic vein tumor thrombosis (HVTT) should undergo systemic therapy. However, recent data suggest that surgical resection may be beneficial in selected cases, but outcomes are heterogenous. We aimed to estimate pooled overall survival (OS), recurrence free survival (RFS) and complication rates in HCC patients with macrovascular invasion (MVI) following surgical resection.

Methods: In this systematic review and meta-analysis, two investigators independently searched PubMed, Embase, and Cochrane databases from inception to Nov 10, 2020, without language restrictions, for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.

Results: We screened 8,598 articles and included 40 studies involving 8,218 patients. Among all patients with MVI, the pooled median OS was 14.39 months [95% confidence interval (CI): 10.99-18.84], 1-year OS was 54.47% (95% CI: 46.12-62.58%) and 3-year OS was 23.20% (95% CI: 16.61-31.42%). Overall, 1- and 3-year RFS were 27.70% (95% CI: 21.00-35.57%) and 10.06% (95% CI: 6.62-15.01%), respectively. Among patients with PVTT, median OS was 20.41 months in those with segmental/2nd order involvement compared to 12.91 months if 1st order branch was involved and 6.41 months if the main trunk was involved. The pooled rate of major complications was 6.17% (95% CI: 3.53-10.56%).

Conclusions: Overall median survival was 14.39 months for HCC patients with MVI following resection. Median survival was higher in PVTT with segmental/2nd order involvement at 20.41 versus 6.41 months if the main trunk was involved.

Keywords: Hepatocellular carcinoma (HCC); macrovascular invasion (MVI); portal vein; recurrence; resection.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-419/coif). MHN has received research grants from Glycotest, Gilead, B. K. Kee Foundation, and National Cancer Institute; MHN serves on the Advisory Board of Intercept, Laboratory of Advanced Medicine, Bayer, Eisai, Gilead, Novartis, Janssen, Eli Lilly, and Exact Sciences. DQH has received a research grant from the National Medical Research Council [Singapore (MOH-000595-01)] and the Exxon-Mobil NUS Scholarship for Clinicians (MOH-000595-01); DQH serves on the Advisory Board of Eisai. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of systematic literature search and screening for analysis of HCC resection outcomes in patients with MVI. PVTT, portal vein tumor thrombosis; HVTT, hepatic vein tumor thrombosis; HCC, hepatocellular carcinoma; MVI, macrovascular invasion.
See this image and copyright information in PMC

Comment in

References

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