Journal
JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES
Volume 28, Issue 12, Pages 1031-1046Publisher
WILEY
DOI: 10.1002/jhbp.865
Keywords
hepatocellular carcinoma; inferior vena cava; meta‐ analysis; radiotherapy; surgery
Categories
Funding
- National Research Fund of Korea [NRF-2019M2D2A1A01031560]
- National Research Foundation of Korea [2019M2D2A1A01031560] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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This meta-analysis looked into the efficacy and safety of surgery and external beam radiotherapy in patients with hepatocellular carcinoma involving the inferior vena cava and/or right atrium. Results showed that surgery had a significantly higher 1-year survival rate compared to EBRT, but it also had a higher complication rate.
We investigated the efficacy and safety of surgery and external beam radiotherapy (EBRT), in patients with hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) through a comparative meta-analysis. A systematic search of PubMed, MEDLINE, EMBASE, and the Cochrane library was performed for entries until July 2020. Eighteen studies with 22 cohorts were included, encompassing 755 patients. The pooled median overall survival (OS) and 1- and 2-year OS rates were 14.2 months, 55.6%, and 27.4%, respectively. The pooled median OS in the surgery and EBRT arms were 15.3 and 11.7 months, respectively. The pooled 1-year OS rate in the surgery arm was significantly higher than that in the EBRT arm (62.4%, 95% CI: 53.8%-70.3% vs 48.8%, 95% CI: 40.9-56.8, respectively; P = .023), while the 2-year OS rates were similar (27.5%, 95% CI: 19.7%-37.1% vs 26.9%, 95% CI: 20.7-34.2, respectively; P = .913). In the surgical arm, the perioperative mortality and grade >= 3 complication rates were 0%-7.6% and 3.9%-67%, respectively. Grade >= 3 complications and radiation-induced liver disease were rarely observed in the EBRT arm. Surgery could be an effective local modality for achieving the best survival rate, though it requires efforts to minimize morbidities and careful patient selection. EBRT, as a noninvasive modality, is a valid palliative option, especially for high-risk patients with a shorter life expectancy.
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