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Resection Plus Post-operative Adjuvant Transcatheter Arterial Chemoembolization (TACE) Compared with Resection Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Multiple studies have demonstrated adjuvant transcatheter arterial chemoembolization (aTACE) after resection improved outcomes compared to resection alone for patients with hepatocellular carcinoma (HCC). Unlike pre-operative TACE which targets a lesion, aTACE is administered in the proximal hepatic artery to destroy cancer cells within the remaining liver. This systematic review and meta-analysis aims to quantify this survival and disease-free survival (DFS) benefit.

Methods

A search of five databases was performed from inception to 20 August 2019.

Results

A total of 26 studies (six randomized controlled trials) involving 7817 patients were included. Patients treated with resection plus aTACE had significantly better 1-year survival (OR, 2.53 [95% CI, 1.70–3.76, p < 0.001) and 1-year DFS (OR, 1.91 [95% CI, 1.60–2.28, p < 0.001) compared to resection alone. The survival benefit remained significant for 2- to 5-year survival (OR 2.39, 1.83, 2.12, 1.87, respectively) and 2- to 4-year DFS (OR 1.85, 1.24, 1.67, respectively). Subgroup analysis showed significant survival benefit with aTACE in microvascular invasion (MVI)-positive HCC, portal venous tumour thrombus (PVTT) that does not involve the main trunk, PVTT-negative, satellite nodules, with and without resection margin < 1 cm. No mortalities were reported with aTACE.

Conclusion

Post-operative aTACE is safe and improves overall and disease-free survival, with the greatest benefit in MVI-positive patients. The current evidence weakly supports the use of adjuvant TACE for patients without PVTT, with PVTT that does not involve the main trunk, with and without a resection margin < 1 cm, and patients with satellite nodules.

Level of Evidence

Level 1

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Authors and Affiliations

  1. Bankstown-Campbelltown Hospital, South Western Sydney Clinical School, UNSW, Sydney, Australia

    Ya Ruth Huo

  2. Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia

    Michael Vinchill Chan & Christine Chan

  3. Sydney Medical School, The University of Sydney, Sydney, Australia

    Michael Vinchill Chan

  4. Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia

    Christine Chan

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  1. Ya Ruth Huo
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  2. Michael Vinchill Chan
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  3. Christine Chan
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Correspondence to Ya Ruth Huo.

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Huo, Y.R., Chan, M.V. & Chan, C. Resection Plus Post-operative Adjuvant Transcatheter Arterial Chemoembolization (TACE) Compared with Resection Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 43, 572–586 (2020). https://doi.org/10.1007/s00270-019-02392-6

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