Aims: Current evidence supporting the efficacy of transarterial chemoembolization (TACE) in Barcelona Clinic Liver Cancer (BCLC)-B hepatocellular carcinoma (HCC) is controversial. The aim of this systematic review was to compare the benefits of liver resection (LR) versus TACE in BCLC-B HCC.
Methods: We conducted a comprehensive literature review of the EMBASE, PubMed, Google Scholar, and Chinese Biomedical Literature databases for retrospective or prospective studies evaluating the efficacy of LR and TACE for the treatment of BCLC-B HCC.
Results: Eleven studies incorporating 3366 patients were included in this analysis. 1-year (RR 0.52 95% CI 0.43-0.63, p < 0.001; I2 = 59%, p = 0.006), 3-year (RR 0.63 95% CI 0.59-0.67, p < 0.001; I2 = 16%, p = 0.29), and 5-year (RR 0.69 95% CI 0.63-0.75, p < 0.001; I2 = 56%, p = 0.021) OS were significantly improved in BCLC-B HCC patients that underwent LR compared to those that underwent TACE. Child-Pugh A liver disease (B vs. A) (HR 1.45 95% CI 1.17-1.79, p < 0.001; I2 = 0%, p = 0.49) and AFP levels (> 400 vs. ≤ 400 ng/ml) (HR 1.36 95% CI 1.09-1.71, p = 0.007; I2 = 90%, p = 0.001) were associated with improved OS.
Conclusion: Liver resection had significant survival benefits over TACE in selected BCLC-B HCC patients in comparison to TACE. However, LR was associated with a significantly increased incidence of treatment-related mortality and infection compared to TACE.
Keywords: BCLC; Hepatocellular carcinoma; Intermediate stage; Resection; Transarterial chemoembolization.