Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis
IntroductionHepatocellular carcinoma (HCC) is a high-grade malignant disease with unfavorable prognosis, and although surgical therapy is necessary, not all patients with HCC are suitable candidates for surgery. Downstaging as preoperative therapeutic strategy, which can convert unresectable HCC int...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.740762/full |
| _version_ | 1818402106452738048 |
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| author | Xinyu Chen Xinyu Chen Lin Lai Jiazhou Ye Lequn Li |
| author_facet | Xinyu Chen Xinyu Chen Lin Lai Jiazhou Ye Lequn Li |
| author_sort | Xinyu Chen |
| collection | DOAJ |
| description | IntroductionHepatocellular carcinoma (HCC) is a high-grade malignant disease with unfavorable prognosis, and although surgical therapy is necessary, not all patients with HCC are suitable candidates for surgery. Downstaging as preoperative therapeutic strategy, which can convert unresectable HCC into resectable HCC, intends to increase the resection rate and improve prognosis.MethodsWe searched multiple databases updated to December 30, 2020, for studies on transcatheter arterial chemoembolization (TACE), Yttrium 90 microsphere selective internal radiation (SIR)/transcatheter radioembolization (TARE), hepatic arterial infusion (HAI), and systemic treatment as downstaging treatment before resection for patients with unresectable HCC.ResultsA total of 20 comparative and non-comparative studies were finally included in the meta-analysis. The pooled downstaging rate of hepatic resection (HR) was 14% [95% confidence interval (CI) 0.10–0.17] with significant heterogeneity (I2 = 94.51%). The chemotherapy, combination, and non-cirrhosis groups exhibit higher rates of downstaging, but these differences were not significant. For comparative studies, the overall survival (OS) rates of resection after downstaging were far better than those inpatients who received locoregional therapy (LRT) or systemic treatment alone at 1 year (RR 1.87, 95% CI 1.48–2.38), 3 years (RR 5.56, 95% CI 2.55–12.10), and 5 years (RR 5.47, 95% CI 2.22–13.49). In addition, the pooled disease-free survival (DFS) rates in patients undergoing HR after successful downstaging were 78% (95% CI 0.62–0.93) at 1 year, 47% (95% CI 0.25–0.68) at 3 years, and 46% (95% CI 0.32–0.59) at 5 years. The pooled OS rates were 88% (95% CI 0.82–0.95) at 1 year, 64% (95% CI 0.59–0.69) at 3 years, and 42% (95% CI 0.29–0.54) at 5 years.ConclusionsDownstaging may serve as a screening tool to identify patients who might benefit from surgery. Resection after successful downstaging can improve prognosis. |
| first_indexed | 2024-12-14T08:03:05Z |
| format | Article |
| id | doaj.art-09cb52965d4442fba09c01aa45948fc8 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-14T08:03:05Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-09cb52965d4442fba09c01aa45948fc82022-12-21T23:10:18ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-11-011110.3389/fonc.2021.740762740762Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-AnalysisXinyu Chen0Xinyu Chen1Lin Lai2Jiazhou Ye3Lequn Li4Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, ChinaDepartment of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, ChinaDepartment of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning, ChinaDepartment of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, ChinaDepartment of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, ChinaIntroductionHepatocellular carcinoma (HCC) is a high-grade malignant disease with unfavorable prognosis, and although surgical therapy is necessary, not all patients with HCC are suitable candidates for surgery. Downstaging as preoperative therapeutic strategy, which can convert unresectable HCC into resectable HCC, intends to increase the resection rate and improve prognosis.MethodsWe searched multiple databases updated to December 30, 2020, for studies on transcatheter arterial chemoembolization (TACE), Yttrium 90 microsphere selective internal radiation (SIR)/transcatheter radioembolization (TARE), hepatic arterial infusion (HAI), and systemic treatment as downstaging treatment before resection for patients with unresectable HCC.ResultsA total of 20 comparative and non-comparative studies were finally included in the meta-analysis. The pooled downstaging rate of hepatic resection (HR) was 14% [95% confidence interval (CI) 0.10–0.17] with significant heterogeneity (I2 = 94.51%). The chemotherapy, combination, and non-cirrhosis groups exhibit higher rates of downstaging, but these differences were not significant. For comparative studies, the overall survival (OS) rates of resection after downstaging were far better than those inpatients who received locoregional therapy (LRT) or systemic treatment alone at 1 year (RR 1.87, 95% CI 1.48–2.38), 3 years (RR 5.56, 95% CI 2.55–12.10), and 5 years (RR 5.47, 95% CI 2.22–13.49). In addition, the pooled disease-free survival (DFS) rates in patients undergoing HR after successful downstaging were 78% (95% CI 0.62–0.93) at 1 year, 47% (95% CI 0.25–0.68) at 3 years, and 46% (95% CI 0.32–0.59) at 5 years. The pooled OS rates were 88% (95% CI 0.82–0.95) at 1 year, 64% (95% CI 0.59–0.69) at 3 years, and 42% (95% CI 0.29–0.54) at 5 years.ConclusionsDownstaging may serve as a screening tool to identify patients who might benefit from surgery. Resection after successful downstaging can improve prognosis.https://www.frontiersin.org/articles/10.3389/fonc.2021.740762/fullhepatic resection (HR)downstaginghepatocellular carcinomaunresectablemeta-analysis |
| spellingShingle | Xinyu Chen Xinyu Chen Lin Lai Jiazhou Ye Lequn Li Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis Frontiers in Oncology hepatic resection (HR) downstaging hepatocellular carcinoma unresectable meta-analysis |
| title | Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis |
| title_full | Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis |
| title_fullStr | Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis |
| title_short | Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis |
| title_sort | downstaging therapies for unresectable hepatocellular carcinoma prior to hepatic resection a systematic review and meta analysis |
| topic | hepatic resection (HR) downstaging hepatocellular carcinoma unresectable meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.740762/full |
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