Comparison of sequential TACE and portal vein embolization with portal vein embolization alone before major hepatectomy in hepatocellular carcinoma: a systematic review and meta-analysis

doi:10.3877/cma.j.issn.2095-5782.2022.03.008

Abstract

Abstract:

Objective

Compare the efficiency and safety of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) versus PVE alone before major hepatectomy for patients with hepatocellular carcinoma (HCC).

Methods

PubMed, the Cochrane Library were screened. The primary endpoints were overall survival rate (OSR), recurrence-free survival rate (RFSR), the increase in the percentage of FLR volume; secondary endpoints were hepatectomy rate, postoperative complications, hepatic failure rate after surgery, and mortality after surgery.

Results

A total of five retrospective studies were included. The results showed the TACE + PVE group had a higher 1-year OSR, 3-year OSR, 5-year OSR, and 10-year OSR than PVE group. The results also indicated the TACE + PVE group had a higher 1-year RFSR, 3-year RFSR, 5-year RFSR, and 10-year RFSR than PVE group. The results demonstrated the TACE + PVE group had a higher FLR volume, as well as higher hepatectomy rate, and lower postoperative complications than PVE group.

Conclusions

Sequential TACE and PVE seem to be a more effective therapy than PVE alone before major hepatectomy for HCC patients, with better survival and safety.

Key words: Hepatocellular carcinoma, Portal vein embolization, Transcatheter arterial chemoembolization, Meta-analysis

Jingyuan Hu, Yong Xie, Huan Tian, Hua Xiang, Ran Peng, Yuzhou Liu, Lu Zhou, Jian Liu, Zhuoyan Cai. Comparison of sequential TACE and portal vein embolization with portal vein embolization alone before major hepatectomy in hepatocellular carcinoma: a systematic review and meta-analysis[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(03): 259-267.

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References 26

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第一作者/出版年份/国家	发表杂志	研究类型	组别	年龄（岁）	性别		肝病背景（例）				肿瘤直径（cm）	PVE与肝切除术的间隔时间	化疗、栓塞材料	结局	文章质量（分）
第一作者/出版年份/国家	发表杂志	研究类型	组别	年龄（岁）	男	女	乙肝	丙肝	酒精肝	其它	肿瘤直径（cm）	PVE与肝切除术的间隔时间	化疗、栓塞材料	结局	文章质量（分）
Ogata/2006/法国^[10]	British Journal of Surgery	回顾性研究（从1998至2004）	TACE + PVE：18	64 ± 7	14	4	4	11			7 ± 3	5.3（4~8）周 $	10~15 mL碘化油（Lipiodol Ultrafluid；Guerbet Laboratories，Paris，France）和40~60 mg阿霉素的混合物，然后用明胶海绵颗粒（Gelfoam；Upjohn Laboratories，Kalamazoo，Michigan，USA）栓塞	①②③⑤⑥⑦⑨⑩⑫⑬	8
Ogata/2006/法国^[10]	British Journal of Surgery	回顾性研究（从1998至2004）	PVE：18	63 ± 9	13	5	6	8			7 ± 2	5.7（4~8）周 $	用氰基丙烯酸酯（Histoacryl；B. Braun，Melsungen，Germany）和碘化油（Lipiodol Ultrafluid）的混合物栓塞门静脉右前、后支	①②③⑤⑥⑦⑨⑩⑫⑬	8
Yoo/2010/韩国^[7]	Annals of surgical oncology	回顾性研究（从1997至2008）	TACE + PVE：71	56.0 ± 9.4	60	11	57	9	3		6.36 ± 5.25	29 d（平均值）	碘化油（Lipiodol；Laboratoire Guerbet，Cedex，France）和顺铂（2 mg/kg）的混合物，然后用直径1 mm的可吸收明胶海绵颗粒（Gelfoam；Upjohn，Kalamazoo，MI）栓塞	①②③④⑤⑥⑦⑧⑩⑪⑫⑬	8
Yoo/2010/韩国^[7]	Annals of surgical oncology	回顾性研究（从1997至2008）	PVE：64	58.2 ± 9.2	56	8	52	3	5		6.66 ± 3.75	31 d（平均值）	门静脉栓塞仅使用明胶海绵（n = 69）、液体栓塞材料Embol-78（n = 25）、带有Amplatzer血管塞的明胶海绵（AGA Medical, Golden Valley，MN）（n = 21）或带线圈的明胶海绵（n = 20）	①②③④⑤⑥⑦⑧⑩⑪⑫⑬	8
Choi/2015/韩国^[11]	Korean J Hepatobiliary Pancreat Surg	回顾性研究（从2003至2011）	TACE + PVE：27	52.3 ± 8.6	21	6	27				5.1 ± 1.7			①②③④	8
Choi/2015/韩国^[11]	Korean J Hepatobiliary Pancreat Surg	回顾性研究（从2003至2011）	PVE：13	53.8 ± 10	13	0	13				4.5 ± 1.3			①②③④	8
Park/2020/韩国^[8]	Hepatobiliary & Pancreatic Diseases International	回顾性研究（从1993至2017）	TACE + PVE：109	52.39 ± 9.2	92	17	93	2	1	13	5.39 ± 2.48	39 （31~49）d	碘化油（Lipiodol；Laboratoire Guerbet，Cedex，France）和顺铂（2 mg/kg）的混合物，然后用可吸收的明胶海绵颗粒（Gelfoam；Upjohn，Kalamazoo，Michigan，USA）栓塞	①②③④⑤⑥⑦⑧⑨⑩⑫	8
Park/2020/韩国^[8]	Hepatobiliary & Pancreatic Diseases International	回顾性研究（从1993至2017）	PVE：38	54.71 ± 8.51	34	4	23	4	0	11	5.94 ± 3.23	23 （20~31）d	栓塞材料包括线圈、凝胶、液体试剂（即聚醋酸乙烯酯）和Amplatzer血管塞（AGA Medical，Golden Valley，MN），可单独使用或混合使用，具体取决于其可用性和操作者偏好	①②③④⑤⑥⑦⑧⑨⑩⑫	8
Terasawa/2020/法国^[9]	Surgery	回顾性研究（从2005至2015）	TACE + PVE：27	65.0 （23.0~83.0）	24	3	5	7	3		8.1（5.0~20.0）	47.0（10~111）d $	注射70 mg多柔比星和10 mg碘油的混合物，然后用明胶海绵颗粒栓塞	①②⑩⑪⑫	8
Terasawa/2020/法国^[9]	Surgery	回顾性研究（从2005至2015）	PVE alone：28	65.0 （44.0~82.0）	25	3	7	2	5		9.0 （5.0~18.0）	47.5（2~250）d $	门静脉区域被氰基丙烯酸酯和碘油的混合物缓慢栓塞	①②⑩⑪⑫	8

第一作者/出版年份/国家	发表杂志	研究类型	组别	年龄（岁）	性别		肝病背景（例）				肿瘤直径（cm）	PVE与肝切除术的间隔时间	化疗、栓塞材料	结局	文章质量（分）
第一作者/出版年份/国家	发表杂志	研究类型	组别	年龄（岁）	男	女	乙肝	丙肝	酒精肝	其它	肿瘤直径（cm）	PVE与肝切除术的间隔时间	化疗、栓塞材料	结局	文章质量（分）
Ogata/2006/法国^[10]	British Journal of Surgery	回顾性研究（从1998至2004）	TACE + PVE：18	64 ± 7	14	4	4	11			7 ± 3	5.3（4~8）周 $	10~15 mL碘化油（Lipiodol Ultrafluid；Guerbet Laboratories，Paris，France）和40~60 mg阿霉素的混合物，然后用明胶海绵颗粒（Gelfoam；Upjohn Laboratories，Kalamazoo，Michigan，USA）栓塞	①②③⑤⑥⑦⑨⑩⑫⑬	8
Ogata/2006/法国^[10]	British Journal of Surgery	回顾性研究（从1998至2004）	PVE：18	63 ± 9	13	5	6	8			7 ± 2	5.7（4~8）周 $	用氰基丙烯酸酯（Histoacryl；B. Braun，Melsungen，Germany）和碘化油（Lipiodol Ultrafluid）的混合物栓塞门静脉右前、后支	①②③⑤⑥⑦⑨⑩⑫⑬	8
Yoo/2010/韩国^[7]	Annals of surgical oncology	回顾性研究（从1997至2008）	TACE + PVE：71	56.0 ± 9.4	60	11	57	9	3		6.36 ± 5.25	29 d（平均值）	碘化油（Lipiodol；Laboratoire Guerbet，Cedex，France）和顺铂（2 mg/kg）的混合物，然后用直径1 mm的可吸收明胶海绵颗粒（Gelfoam；Upjohn，Kalamazoo，MI）栓塞	①②③④⑤⑥⑦⑧⑩⑪⑫⑬	8
Yoo/2010/韩国^[7]	Annals of surgical oncology	回顾性研究（从1997至2008）	PVE：64	58.2 ± 9.2	56	8	52	3	5		6.66 ± 3.75	31 d（平均值）	门静脉栓塞仅使用明胶海绵（n = 69）、液体栓塞材料Embol-78（n = 25）、带有Amplatzer血管塞的明胶海绵（AGA Medical, Golden Valley，MN）（n = 21）或带线圈的明胶海绵（n = 20）	①②③④⑤⑥⑦⑧⑩⑪⑫⑬	8
Choi/2015/韩国^[11]	Korean J Hepatobiliary Pancreat Surg	回顾性研究（从2003至2011）	TACE + PVE：27	52.3 ± 8.6	21	6	27				5.1 ± 1.7			①②③④	8
Choi/2015/韩国^[11]	Korean J Hepatobiliary Pancreat Surg	回顾性研究（从2003至2011）	PVE：13	53.8 ± 10	13	0	13				4.5 ± 1.3			①②③④	8
Park/2020/韩国^[8]	Hepatobiliary & Pancreatic Diseases International	回顾性研究（从1993至2017）	TACE + PVE：109	52.39 ± 9.2	92	17	93	2	1	13	5.39 ± 2.48	39 （31~49）d	碘化油（Lipiodol；Laboratoire Guerbet，Cedex，France）和顺铂（2 mg/kg）的混合物，然后用可吸收的明胶海绵颗粒（Gelfoam；Upjohn，Kalamazoo，Michigan，USA）栓塞	①②③④⑤⑥⑦⑧⑨⑩⑫	8
Park/2020/韩国^[8]	Hepatobiliary & Pancreatic Diseases International	回顾性研究（从1993至2017）	PVE：38	54.71 ± 8.51	34	4	23	4	0	11	5.94 ± 3.23	23 （20~31）d	栓塞材料包括线圈、凝胶、液体试剂（即聚醋酸乙烯酯）和Amplatzer血管塞（AGA Medical，Golden Valley，MN），可单独使用或混合使用，具体取决于其可用性和操作者偏好	①②③④⑤⑥⑦⑧⑨⑩⑫	8
Terasawa/2020/法国^[9]	Surgery	回顾性研究（从2005至2015）	TACE + PVE：27	65.0 （23.0~83.0）	24	3	5	7	3		8.1（5.0~20.0）	47.0（10~111）d $	注射70 mg多柔比星和10 mg碘油的混合物，然后用明胶海绵颗粒栓塞	①②⑩⑪⑫	8
Terasawa/2020/法国^[9]	Surgery	回顾性研究（从2005至2015）	PVE alone：28	65.0 （44.0~82.0）	25	3	7	2	5		9.0 （5.0~18.0）	47.5（2~250）d $	门静脉区域被氰基丙烯酸酯和碘油的混合物缓慢栓塞	①②⑩⑪⑫	8

生存率	Egger检验（P值）	Begg检验（P值）
1年生存率	0.48	0.462
3年生存率	0.736	1.00
5年生存率	0.622	0.734

生存率	Egger检验（P值）	Begg检验（P值）
1年生存率	0.48	0.462
3年生存率	0.736	1.00
5年生存率	0.622	0.734

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