Hepatocellular carcinoma with macrovascular invasion: Review and survival meta-analysis of initial local therapy using minimal prognostic criteria
Background and Aims: Macrovascular invasion (MaVI) defines advanced-stage hepatocellular carcinoma (HCC) and typically mandates systemic therapy, yet some guidelines advocate surgery or locoregional approaches. We conducted a systematic review and meta-analysis of overall survival (OS) in HCC with M...
| Autores: | , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Conselleria de Salut i Consum del Govern de les Illes Balears |
| Repositorio: | Docusalut |
| Idioma: | inglés |
| OAI Identifier: | oai:docusalut.com:20.500.13003/26543 |
| Acceso en línea: | https://hdl.handle.net/20.500.13003/26543 |
| Access Level: | acceso abierto |
| Palabra clave: | Thrombosis Trombosis EBRT TACE TARE portal vein tumor thrombus resection |
| Sumario: | Background and Aims: Macrovascular invasion (MaVI) defines advanced-stage hepatocellular carcinoma (HCC) and typically mandates systemic therapy, yet some guidelines advocate surgery or locoregional approaches. We conducted a systematic review and meta-analysis of overall survival (OS) in HCC with MaVI treated with approaches other than systemic therapy, enforcing stringent inclusion criteria to exclude studies lacking a minimal prognostic dataset and to improve cohort comparability. Approach and Results: PRISMA-guided methods were used (CRD420251051847). PubMed was searched (January 2008 to November 2024). Eligible studies reported OS for HCC with MaVI and provided baseline performance status and liver function; studies without adequate prognostic information were excluded. Data on OS at 1, 2, 3, and 5 years were extracted, and heterogeneity was assessed. Seventy-three studies met criteria (104 treatment arms; 10,329 patients). Despite a rigorous identification process, substantial heterogeneity persisted for most modalities ( I 2 >80%), precluding robust pooling. Transarterial radioembolization (TARE) monotherapy was the only treatment with low heterogeneity ( I 2 =0%) and showed a pooled 1-year OS of 34% (95% CI: 20%–48%). Apparent advantages of sequential strategies likely reflected confounding by indication and immortal-time bias, as only patients who lived long enough and were sufficiently fit proceeded through the full sequence. Data completeness declined beyond 12 months (missing OS: 0% at 1 y; 17.3% at 2 y; 32.7% at 3 y; 70.2% at 5 y). Conclusions: In HCC with MaVI, 1-year OS is the most comparable endpoint across modalities. This analysis identifies TARE as the only consistently reproducible option, showing a 1-year survival of 34%. In contrast, surgery and sequential therapies remain confounded by substantial heterogeneity. Accordingly, stratified head-to-head trials comparing alternative modalities against immunotherapy are warranted. |
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