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 hepa- tocellular carcinoma (HCC) patients. This study aimed to evaluate the efficacy and safety 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 appropriate articles published prior to March 11, 2019. The primary endpoint was the survival (OS) of patients treated using adjuvant TACE after hepatectomy (HTAT) versus hepate-ctomy (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 DES (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 DES (P=0.066) as compared with HT. For HCC larger than 5 cm, 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 >5 cm is not clear. Further randomized controlled studies are warranted to test these conclusions. (C) 2019 Published by Elsevier Masson SAS.