To systematically review the clinical effectiveness of combined postoperative adjuvant transcatheter arterial chemoembolization (TACE) with portal vein chemotherapy (PVC) versus TACE alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).

Databases including PubMed, Embase, Cochrane Library, Medline, Web of Science, CNKI, China Biology Medicine, Wan Fang and VIP were searched from Jan 1st 2000 to Jun 30th 2019 for eligible studies on clinical effectiveness of combined postoperative adjuvant TACE with PVC versus TACE alone in patients with HCC and PVTT. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoint was adverse events. These endpoints were evaluated by odds ratio (OR) and 95% confidence interval (CI) using Review Manager 5.3 software.

Nine studies with 642 patients were enrolled in this meta-analysis. There were 323 patients in the TACE group and 319 patients in the TACE plus PVC group. The pooled OR for the 1-, 2-, and 3-year OS were all significantly better in the TACE plus PVC group than the TACE group (1-year OS, OR=2.20, 95% CI: 1.53-3.17; 2-year OS, OR=2.44, 95% CI: 1.69-3.53; 3-year OS, OR=2.30, 95% CI: 1.52-3.46) (all P<0.05). Similarly, significantly better results were observed in the pooled OR for the 1-, 2-, and 3-year DFS (1-year DFS, OR=2.56, 95% CI: 1.70-3.86; 2-year DFS, OR=2.27, 95% CI: 1.19-4.32; 3-year DFS, OR=3.03, 95% CI: 1.55-5.92) (all P<0.05). There were no significant differences in the incidences of adverse events between the two groups (all P>0.05).

Postoperative adjuvant TACE combined with PVC for patients with HCC and PVTT was safe and effective, and was significantly better than TACE alone in long-term prognosis. Large-scale, multi-center, prospective studies are needed to support the conclusion.

Carcinoma, hepatocellular; Portal vein tumor thrombosis; Transarterial chemoembolization; Portal vein chemotherapy; Meta-analysis