Hepatocellular carcinoma with macrovascular invasion: Review and survival meta-analysis of initial local therapy using minimal prognostic criteria.
Marta Fortuny, Antonio De Rosa, Ignacio Roca et al.
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In 30 seconds
This PRISMA-guided systematic review and meta-analysis assessed overall survival after initial local therapies, rather than systemic therapy, for hepatocellular carcinoma with macrovascular invasion. It included 73 studies, comprising 104 treatment arms and 10,329 patients, with baseline performance status and liver function required for inclusion. Heterogeneity remained substantial for most treatment modalities, limiting robust pooling. Transarterial radioembolization monotherapy was the only modality with no observed heterogeneity (I² =0%) and had a pooled 1-year overall survival of 34% (95% CI: 20%-48%).
Key findings
- Across 73 studies, 104 treatment arms and 10,329 patients were included.
- TARE monotherapy had a pooled 1-year overall survival of 34% (95% CI: 20%-48%) and I² =0%.
- Heterogeneity exceeded I² >80% for most modalities, precluding robust pooling.
- Overall-survival data were missing for 0% at 1 y, 17.3% at 2 y, 32.7% at 3 y and 70.2% at 5 y.
Why it matters
Macrovascular invasion marks advanced HCC, but local approaches are used in some settings despite systemic therapy typically being indicated. This review shows why comparisons across local modalities are difficult: cohorts and results were highly heterogeneous, and longer-term survival data were often incomplete. The findings help frame the evidence as exploratory rather than establishing comparative treatment effectiveness.
What to keep in mind
Substantial heterogeneity persisted for most modalities, and the authors identify confounding by indication and immortal-time bias in apparent advantages of sequential strategies. Survival data completeness declined markedly beyond 12 months.