Transarterial chemoembolization (TACE) combined with sorafenib versus TACE for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Background. The benefits of transarterial chemoembolization plus sorafenib (TACE-S) in hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) remain controversial. We compared the effectiveness and safety of TACE-S and TACE for HCC with PVTT. Methods. The Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure, VIP, Wan Fang, and Sino Med databases were systematically searched for studies of HCC with PVTT treated using TACE-S. Two authors independently extracted study outcomes, including overall survival (OS), time to progression (TTP), objective response (tumor response) and adverse events (AEs). Results. Eight high-quality, retrospective studies with 1091 patients (TACE-S= 356, TACE= 735) were included in the review. Five retrospective studies with 973 patients (TACE-S= 238, TACE= 735) were included in the meta-analysis. The objective response rate (ORR, OR= 3.59, 95% CI= 1.74-7.39; I-2= 21%, P= 0.0005) and disease control rate (DCR, OR= 4.72, 95% CI= 1.75-12.72; I-2= 56%, P= 0.002) favored TACE-S TACE-S significantly increased 6-month OS (OR= 3.47; 95% CI= 2.47-4.89; I-2= 0%, P < 0.00001) and 1-year OS (OR= 3.10; 95% CI= 2.22-4.33; I-2= 41%, P < 0.00001). The hazard ratio (HR) for OS (HR=0.62; 95% CI= 0.51-0.75; I-2= 30%, P < 0.00001) also indicated that TACE-S was superior to TACE. TACE-S with PVTT had better outcomes in the first-order portal vein branch and lower-order portal vein branches than in the main portal vein and upper branches to superior mesenteric vein. The most common AEs were hand-foot skin reaction (HFSR, 178; 73%), diarrhea 142; 58%) and alopecia (76; 31%); AEs of grade 3/4 were rare. Conclusions. TACE-S may improve OS, ORR, TTP and DCR for HCC patients with PVTT compared to TACE.