Does size matter for resection of giant versus non-giant hepatocellular carcinoma? A meta-analysis

Abstract

Background: Research on long-term survival after resection of giant (≥ 10 cm) and non-giant hepatocellular carcinoma (HCC) (< 10 cm) has produced conflicting results.

Aim: This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.

Methods: PubMed, MEDLINE, EMBASE, and Cochrane databases were searched. Studies designed to investigate the outcomes of giant vs non-giant HCC were included. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative complications and mortality rates. All studies were assessed for bias using the Newcastle-Ottawa Scale.

Results: 24 retrospective cohort studies involving 23747 patients (giant = 3326; non-giant = 20421) who underwent HCC resection were included. OS was reported in 24 studies, DFS in 17 studies, 30-d mortality rate in 18 studies, postoperative complications in 15 studies, and post-hepatectomy liver failure (PHLF) in six studies. The HR was significantly lower for non-giant HCC in both OS (HR 0.53, 95%CI: 0.50-0.55, P < 0.001) and DFS (HR 0.62, 95%CI: 0.58-0.84, P < 0.001). No significant difference was found for 30-d mortality rate (OR 0.73, 95%CI: 0.50-1.08, P = 0.116), postoperative complications (OR 0.81, 95%CI: 0.62-1.06, P = 0.140), and PHLF (OR 0.81, 95%CI: 0.62-1.06, P = 0.140).

Conclusion: Resection of giant HCC is associated with poorer long-term outcomes. The safety profile of resection was similar in both groups; however, this may have been confounded by reporting bias. HCC staging systems should account for the size differences.

Keywords: Giant hepatocellular carcinoma; Hepatectomy; Meta-analysis; Resection.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram.

Figure 2

Overall survival curves, numbers-at-risk table and Forest plot. A: Overall survival (OS) curves and numbers-at-risk table for giant vs non-giant hepatocellular carcinoma from reconstructed individual patient data; B: OS forest plot. HCC: Hepatocellular carcinoma; HR: Hazard ratio; RMST: Restricted mean survival time.

Figure 3

Disease-free survival curve, numbers-at-risk table and Forest plot. A: Disease-free survival (DFS) curves and numbers-at-risk table for giant vs non-giant hepatocellular carcinoma from reconstructed individual patient data; B: DFS forest plot. HCC: Hepatocellular carcinoma; HR: Hazard ratio; RMST: Restricted mean survival time.

Figure 4

Forest plots for morbidity and 30-d mortality. A: Forest plot of the 30-d mortality rate; B: Forest plot of the postoperative complication rate; C: Forest plot of post-hepatic liver failure rate. HCC: Hepatocellular carcinoma.