Long-term survival and postoperative complications of pre-liver transplantation transarterial chemoembolisation in hepatocellular carcinoma: A systematic review and meta-analysis |
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| Affiliation: | 1. The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, 4102, Australia;2. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia;3. Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, QLD, Australia;4. The Prince Charles Hospital, Chermside, QLD, Australia;1. Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA;2. European Interbalkan Medical Center, Asklipiou 10, Pilea, 555 35, Thessaloniki, Greece;3. Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece;1. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK;2. Radboudumc, Nijmegen, the Netherlands;3. University Medical Center Hamburg-Eppendorf, Hamburg, Germany;4. Department of Urology, Ruhr University Bochum, Klinikum, Herford, Germany;5. Urological Clinic Department of Surgical Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy;6. Department of Urology, St George''s University Hospitals NHS Trust, London, UK;7. NIHR Biomedical Research Centre UCLH and Division of Surgery and Interventional Science UCL, London, United Kingdom;8. Universitair Ziekenhuis Leuven, Leuven, Belgium;9. Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children''s Hospital, Nijmegen, the Netherlands;1. SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France;2. Sorbonne Université, Paris, France;3. Unit of Biometry, Institut Curie, DRCI, PSL Research University, Paris, France;4. Department of Biopathology, Centre Léon Bérard, Lyon, France;5. Department of Pediatric and Adolescent Hematology and Oncology, Pellegrin Hospital, Bordeaux, France;6. Department of Pediatric and Adolescent Oncology, Centre Leon Berard, Lyon, France;7. Department of Orthopedic Surgery, Hôpital Necker-Enfants-Malades, Université de Paris, Paris, France;8. Centre Léon Bérard, Department of Surgery, Lyon, France;9. Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France;10. Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France;11. Imaging Department, Oscar Lambret Centre, Lille, France;12. Department of Medical Oncology, Centre Léon Bérard, Lyon, France;13. Department of Orthopedic Surgery, CHRU de Tours, Faculté de Médecine de Tours, Université François Rabelais, Tours, France;14. Department of Biopathology, Institut Bergonié, Université de Bordeaux, Bordeaux, France;15. Institut Curie, Imaging Department, Paris, France;p. Department of Pediatric Orthopedic Surgery, Hôpital Femme Mere Enfant, Lyon, France;q. Department of Genetics, Institut Curie, Paris, France;r. Department of Translational Research and Innovation, Centre Léon Bérard, Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France;s. Department of Pediatric and Adolescent Oncology, Oscar Lambret Centre, Lille, France;t. Department of Medical Oncology, Institut Bergonié, Bordeaux, France;1. Department of Surgical Oncology, Institute Curie, Paris Sciences et Lettres University, Paris, France;2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy;3. Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy;4. Division of Plastic and Reconstructive Surgery, Institute Curie, Paris, France;5. Department of Vascular Surgery, Hospital Saint Joseph, Paris, France;6. Department of Radiation Oncology, Institute Curie, Paris, France;7. Department of Radiology, Institute Curie, Paris, France;8. Department of Medical Information, Institute Curie, Paris, France;1. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland;2. Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland |
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| Abstract: | ObjectivesThe aim of this meta-analysis was to conduct a contemporary systematic review of high quality non-randomised controlled trials to determine the effect of pre-liver transplantation (LT) transarterial chemoembolisation (TACE) on long-term survival and complications of hepatocellular carcinoma (HCC) patients.BackgroundTACE is used as a neoadjuvant therapy to mitigate waitlist drop-out for patients with HCC awaiting LT. Previous studies have conflicting conclusions on the effect of TACE on long-term survival and complications of HCC patients undergoing LT.MethodsCINAHL, Cochrane Controlled Register of Trials, Embase, PubMed, and Web of Science were systematically searched. Baseline characteristics included number of patients outside Milan criteria, tumour diameter, MELD score, and time on the waiting list. Primary outcomes included 3- and 5-year overall and disease-free survival. Secondary outcomes included tumour recurrence, 30-day postoperative mortality, and hepatic artery and biliary complications.ResultsTwenty-one high-quality NRCTs representing 8242 patients were included. Tumour diameter was significantly larger in TACE patients (3.49 cm vs 3.15 cm, P = 0.02) and time on the waiting list was significantly longer in TACE patients (4.87 months vs 3.46 months, P = 0.05), while MELD score was significantly higher in non-TACE patients (10.81 vs 12.35, P = 0.005). All primary and secondary outcomes displayed non-significant differences.ConclusionPatients treated with TACE had similar survival and postoperative outcomes to non-TACE patients, however, they had worse prognostic features compared to non-TACE patients. These findings strongly support the current US and European clinical practice guidelines that neoadjuvant TACE can be used for patients with longer expected waiting list times (specifically >6 months). Randomised controlled trials would be needed to increase the quality of evidence. |
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| Keywords: | Meta-analysis Transarterial chemoembolisation Liver transplantation Hepatocellular carcinoma |
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