Xuan Wangyi, Zhang Xiaoming, Fang Yingying, Zhang Yueming, Xiang Zhiyi, Yu Yifei, Wu Qingping, Zhang Xingfen
Department of Gastroenterology, Ningbo Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, Zhejiang 315299, P.R. China.
The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China.
Oncol Lett. 2025 Jan 7;29(3):122. doi: 10.3892/ol.2025.14868. eCollection 2025 Mar.
Hepatocellular carcinoma (HCC) with coexisting portal vein tumor thrombus (PVTT) is associated with poor patient outcomes. The efficacy and safety of neoadjuvant therapy in patients with HCC with PVTT remain a subject of debate. In the present study, a comprehensive search of electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, was conducted to identify studies evaluating the outcomes of neoadjuvant therapy in patients with HCC and PVTT. The primary outcomes assessed were overall survival (OS) and relapse-free survival (RFS), with complication rates as a secondary outcome. A total of six studies comprising 750 patients were included in the present meta-analysis. The neoadjuvant therapy group exhibited significantly superior OS [hazard ratio (HR), 0.39; P<0.001] and RFS (HR, 0.31; P<0.001) compared with the primary hepatectomy control group. Compared with the control group, neoadjuvant radiotherapy improved OS (HR, 0.34; P<0.001) and RFS (HR, 0.24; P=0.004). While the neoadjuvant intervention subgroup exhibited an improved OS compared with controls (HR, 0.37; P=0.001), no significant difference in RFS was observed (HR, 0.11; P=0.095). Geographical analysis revealed that the Chinese subgroup demonstrated a significantly improved OS and RFS (HR, 0.41 for both; P<0.001), compared with the control group. However, the Japanese and Korean subgroups showed no improvement in OS (HR, 0.25; P=0.057) compared with the control group, and the results did not reach statistical significance. There were no significant differences between the groups in terms of blood transfusion, blood loss, operation time, bile leakage, ascites, peritoneal infection, postoperative bleeding, complications or mortality (all P>0.05). Overall, neoadjuvant therapy significantly improved survival outcomes in patients with HCC and PVTT without increasing complication rates, supporting its efficacy and manageable safety profile.
伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者预后较差。新辅助治疗在伴有PVTT的HCC患者中的疗效和安全性仍是一个有争议的话题。在本研究中，我们全面检索了包括PubMed、Web of Science、Embase和Cochrane图书馆在内的电子数据库，以确定评估新辅助治疗对伴有PVTT的HCC患者疗效的研究。评估的主要结局为总生存期（OS）和无复发生存期（RFS），并发症发生率作为次要结局。本荟萃分析共纳入6项研究，涉及750例患者。与一期肝切除对照组相比，新辅助治疗组的OS（风险比[HR]，0.39；P<0.001）和RFS（HR，0.31；P<0.001）显著更优。与对照组相比，新辅助放疗改善了OS（HR，0.34；P<0.001）和RFS（HR，0.24；P=0.004）。虽然新辅助干预亚组与对照组相比OS有所改善（HR，0.37；P=0.001），但在RFS方面未观察到显著差异（HR，0.11；P=0.095）。地理分析显示，与对照组相比，中国亚组的OS和RFS显著改善（两者HR均为0.41；P<0.001）。然而，日本和韩国亚组与对照组相比OS未改善（HR，0.25；P=0.057），结果未达到统计学显著性。各组在输血、失血、手术时间、胆漏、腹水、腹腔感染、术后出血、并发症或死亡率方面均无显著差异（所有P>0.05）。总体而言，新辅助治疗显著改善了伴有PVTT的HCC患者的生存结局，且未增加并发症发生率，支持其疗效和可控的安全性。
