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Cited 141 time in webofscience Cited 140 time in scopus
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Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: A meta-analysis of high-quality studies

Authors
Hyun, Myung HanLee, Young-SunKim, Ji HoonLee, Chan UkJung, Young KulSeo, Yeon SeokYim, Hyung JoonYeon, Jong EunByun, Kwan Soo
Issue Date
Sep-2018
Publisher
John Wiley & Sons Inc.
Citation
Hepatology, v.68, no.3, pp 977 - 993
Pages
17
Indexed
SCI
SCIE
SCOPUS
Journal Title
Hepatology
Volume
68
Number
3
Start Page
977
End Page
993
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/3193
DOI
10.1002/hep.29883
ISSN
0270-9139
1527-3350
Abstract
According to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines for hepatocellular carcinoma (HCC), the role of surgery has been expanded beyond the Barcelona Clinic Liver Cancer (BCLC) algorithm. We compared primary hepatectomy (PH) with transarterial chemoembolization (TACE) in patients with intermediate- to advanced-stage (BCLC stage B/C) HCC to determine the current evidence. Through a database search, we included 18 high-quality studies (one randomized controlled trial [RCT], five propensity-score matching nonrandomized comparative trials [NRCTs], and 12 NRCTs) that compared survival outcomes of 5,986 patients after PH and TACE. We found significant survival benefits for PH over TACE in BCLC stage B/C patients (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.51-0.67; P < 0.00001; I-2 = 84%). According to the BCLC, both stage B and stage C patients showed significantly better overall survival (OS) for PH compared to TACE (HR, 0.53; 95% CI, 0.43-0.65; P < 0.00001; I-2 = 77%; HR, 0.67; 95% CI, 0.59-0.77; P < 0.00001; I-2 = 79%, respectively). Five-year survival rates for PH were significantly higher than those for TACE in BCLC stage B/C, stage B, and BCLC stage C patients (odds ratio [OR], 2.71, 2.77, and 3.03, respectively; all P < 0.00001). Survival benefits persisted across subgroup, sensitivity, and metaregression analyses; interstudy heterogeneity remained constant. Conclusion: This meta-analysis suggests that surgical resection provides survival benefits in patients with intermediate- to advanced-stage HCC. The evidence found herein may assist in the choice of treatment modality based on diverse definitions of operability. (Hepatology 2018).
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Lee, Young Sun
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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