The effectiveness and safety of therapies for hepatocellular carcinoma with tumor thrombus in the hepatic vein, inferior vena cave and/or right atrium: a systematic review and single-arm meta-analysis.
Qing-Bo Wang, Jin Li, Zi-Jun Zhang, Yu-Kai Li, Yu-Bo Liang, Xing-Ming Chen, Wan-Ling Luo, Yawhan Lakang, Zi-Sheng Yang, Guan-Yi Liu, Yu Liu, Shuang-Xi Li, Yang Ke
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Abstract
Background: This review evaluates the efficacy and safety of therapies for hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus (HVTT), inferior vena cava tumor thrombus (IVCTT), and/or right atrium tumor thrombus (RATT).
Research design and methods: A systematic review of PubMed, EMBASE, Cochrane Library, and Wanfang databases up to 22 August 2024, was conducted, focusing on overall survival (OS), progression -free survival (PFS), and adverse reactions.
Results: Seven studies involving 453 patients were analyzed. Treatment strategies included surgery alone, local ± systemic therapy, and surgery with adjuvant therapy. The pooled 1-, 3-, and 5-year OS rates for all patients were 63.3%, 21.6% , and 8.3%, respectively. Surgery with adjuvant therapy achieved the highest 1-year OS, while local ± systemic therapy led to the best 5-year OS. The pooled 1-, 3-, and 5-year PFS rates for all patients were 56.8%, 9.4%, and 1.6%, respectively. Surgery alone commonly caused ascites and pleural effusion; the local ± systemic therapy commonly caused hepatic dysfunction and platelet abnormalities; and surgery with adjuvant therapy commonly caused peritoneal abscess.
Conclusion: Local ± systemic therapy provided the best long-term OS and manageable complications among the therapeutic strategies for HCC with HVTT, IVCTT, and/or RATT.
背景：本综述评价肝细胞癌（HCC）合并肝静脉肿瘤血栓（HVTT）、下腔静脉肿瘤血栓（IVCTT）和/或右心房肿瘤血栓（RATT）治疗的有效性和安全性。研究设计与方法：对截至2024年8月22日的PubMed、EMBASE、Cochrane Library和万方数据库的相关文献进行系统综述，重点关注总生存期（OS）、无进展生存期（PFS）和不良反应。结果：共分析了7项涉及453例患者的研究。治疗策略包括单纯手术、局部±全身治疗和手术配合辅助治疗。所有患者的1年、3年和5年总生存率分别为63.3% （95% CI 52.7%-73.9%）、21.6% （95% CI 4.9%-38.2%）和8.3% （95% CI 2.9%-13.8%）。手术配合辅助治疗获得最高的1年OS，而局部±全身治疗获得最佳的5年OS。所有患者的1年、3年和5年PFS合计分别为56.8% （95% CI 45.2%-68.4%）、9.4% （95% CI 0.0%-20.0%）和1.6% （95% CI 0.0%-3.8%）。单纯手术多出现腹水、胸腔积液等不良反应，局部±全身治疗多出现肝功能障碍、血小板异常，手术及辅助治疗多伴有腹膜脓肿。结论：在HVTT、IVCTT和/或RATT治疗HCC的三种治疗策略中，局部±全身治疗提供了最佳的长期OS和可控的并发症。注册：普洛斯彼罗，（CRD42024573152）。
期刊介绍：
Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches.
Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care.
Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections:
Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results
Article Highlights – an executive summary of the author’s most critical points.
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