Surgical versus Non-surgical Treatment for Hepatocellular Carcinoma with Macrovascular Invasion: A Systematic Review and Meta-analysis

Background The prognosis of hepatocellular carcinoma (HCC) with macrovascular invasion (MaVI) is poor. The meta-analysis was aimed to compare the overall survival (OS) rates of surgical treatment (ST) with non-surgical treatment (NST).

Methods We searched studies from January 1990 to July 2023 through PubMed, Embase and Cochrane database. Primary and secondary subgroup analysis based on different types of tumor thrombosis were performed, including portal vein tumor thrombosis (PVTT) and hepatic vein tumor thrombosis (HVTT)/inferior vena cava tumor thrombosis (IVCTT).

Results A total of 33 studies were included. The 1-year, 3-year, and 5-year OS (All P<0.001) were significantly higher in ST group. Primary subgroup analysis showed that ST group with PVTT displayed higher 1-year, 3-year and 5-year OS (All P<0.001). Additionally, HCC patients with HVTT/IVCTT receiving ST had better 1-year (P=0.048), 3-year (P<0.001) and 5-year OS (P=0.046). Secondary subgroup analysis demonstrated that ST group with Type I PVTT exhibited longer 1-year OS (P=0.001) while the difference was not observed in Type II PVTT. Surgery provided longer 3-year (P=0.001; P<0.001) and 5-year OS (P=0.042; P=0.001) for patients with Type I and II PVTT, respectively. The 1-year (P=0.05), 3-year (P<0.001) and 5-year (P=0.027) OS of patients with HVTT were higher in ST group. There was no difference of OS in patients with IVCTT.

Conclusions Surgery should be recommended for HCC with Type I/II PVTT or HVTT.

Publication History

Article published online:
23 January 2024