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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Autores principales:	Xinyu Chen, Lin Lai, Jiazhou Ye, Lequn Li
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	hepatic resection (HR) downstaging hepatocellular carcinoma unresectable meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/09cb52965d4442fba09c01aa45948fc8
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spelling	oai:doaj.org-article:09cb52965d4442fba09c01aa45948fc82021-11-19T04:42:26ZDownstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis2234-943X10.3389/fonc.2021.740762https://doaj.org/article/09cb52965d4442fba09c01aa45948fc82021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.740762/fullhttps://doaj.org/toc/2234-943XIntroductionHepatocellular 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.Xinyu ChenXinyu ChenLin LaiJiazhou YeLequn LiFrontiers Media S.A.articlehepatic resection (HR)downstaginghepatocellular carcinomaunresectablemeta-analysisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hepatic resection (HR) downstaging hepatocellular carcinoma unresectable meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	hepatic resection (HR) downstaging hepatocellular carcinoma unresectable meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 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
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.
format	article
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
title	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_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_sort	downstaging therapies for unresectable hepatocellular carcinoma prior to hepatic resection: a systematic review and meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/09cb52965d4442fba09c01aa45948fc8
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Downstaging Therapies for Unresectable Hepatocellular Carcinoma Prior to Hepatic Resection: A Systematic Review and Meta-Analysis

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