Adjuvant transarterial chemoembolization after curative hepatectomy for hepatocellular carcinoma with microvascular invasion: A systematic review and meta-analysis

Objective: Microvascular invasion (MVI) has been associated with a poor prognosis for hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the efficacy and safety of adjuvant transarterial chemoembolization (TACE) after curative hepatectomy for HCC with MVI.

Methods: An online search on Embase and Ovid MEDLINE(R) was conducted to identify the appropriate articles published prior to March 11, 2019. The primary endpoint was the overall survival (OS) of patients treated using adjuvant TACE after hepatectomy (HTAT) versus hepatectomy (HT) alone for HCC with MVI. The secondary endpoints were disease-free survival (DFS) and safety.

Results: Seven studies with 1869 patients were included in this analysis. Meta-analyses demonstrated that HTAT was superior to HT in OS (Hazard Ratio [HR]: 0.67, 95%CI: 0.58-0.77, P<0.001) and DFS (HR: 0.71, 95%CI: 0.62-0.81, P<0.001) for treating HCC with MVI. Subgroup analysis revealed that for early-stage HCC, HTAT was associated with longer OS (P=0.009) and DFS (P=0.066) as compared with HT. For HCC larger than 5cm, HTAT also prolonged the DFS (P=0.008) of patients, but the difference in OS was not statistically significant (P=0.266). Adjuvant TACE commonly caused nausea and vomiting, liver dysfunction, leucopenia, pain, and fever.

Conclusions: Adjuvant TACE after hepatectomy is effective and safe for patients with HCC accompanied by MVI. However, the benefit of adjuvant TACE in patients who have HCC with a diameter >5cm is not clear. Further randomized controlled studies are warranted to test these conclusions.