Background
Methods
Search strategy
Study selection
Inclusion criteria
Exclusion criteria
Data extraction and quality assessment
Statistical analysis
Results
Identification of eligible studies
Patient characteristics
Study(year) | Study design | Treatment | Country | Patients | AGE | Sex(M/F) | Tumor size(cm) (<5/≥5) | Tumor Number (S/M) |
aType of PVTT (I/II/III/IV) | Child-Pugh (A/B/C) | Virology HBV/Other | Cirrhosis (Yes/No) | Total bilirubin level (μmol/L) | Serum albumin level (g/L) | AFP(mg/L) (<400/≥400) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fan 2001 [20] | R(1996-1998) | HR | China | 74 | 48.2(20-70) | NA | 35/39 (≥10/<10) | 46/28 | 0/58/16/0 | NA | NA | NA | NA | NA | NA |
TACE | 18 | 48.2(20-70) | NA | 13/5(≥10/<10) | 13/5 | 0/12/6/0 | NA | NA | NA | NA | NA | NA | |||
Fan 2003 [19] | R(1997-2000) | HR | China | 19 | 47 (26-75) (All)b
| 122/16 (All) | 9/10 (≥10/<10) | 10/9 | 0/14/5/0 | 105/33/0 (All) | 103/35 (All) | NA | NA | NA | 108/30 (≥10/<10) ng/ml(All) |
TACE | 41 | 47 (26-75) (All) | 122/16 (All) | 21/20 (≥10/<10) | 26/15 | 0/26/15/0 | 105/33/0 (All) | 103/35 (All) | NA | NA | NA | 108/30 (≥10/<10) ng/ml(All) | |||
Cheng 2005 [18] | R(2000-2003) | HR | China | 7 | 47.5 ± 6.9 | 5/2 | 62.7 ± 49.8 (mm) | 7/0 | 2/4/1/0 | NA | 6/1/ | NA | NA | NA | 5/2(≥20/<20) μg/L |
TACE | 38 | 47.9 ± 10.6 | 35/3 | 62.7 ± 49.8 (mm) | 30/8 | 6/11/20/1 | NA | 32/6 | NA | NA | NA | 28/10 (≥20/<20)μg/L | |||
Fan 2005 [21] | R(1997-2002) | HR | China | 24 | 15/9 (≥45/<45) | 20/4 | 11/13 (≥10/<10) | 14/10 | 0/16/8/0 | 18/6/0 | NA | NA | NA | NA | NA |
TACE | 53 | 25/28 (≥45/<45) | 49/4 | 28/25 (≥10/<10) | 33/20 | 0/30/23/0 | 39/14/0 | NA | NA | NA | NA | NA | |||
Zhou 2011 [25] | R(2003-2010) | HR | China | 38 | 22/16 (≥50/<50) | 35/3 | 13/25 | 27/11 | 0/25/13/0 | 27/11/0 | 36/2 | 14/24 | NA | NA | 14/24 |
TACE | 10 | 5/5 (≥50/<50) | 10/0 | 8/2 | 3/7 | 0/4/6/0 | 4/6/0 | 10/0 | 9/1 | NA | NA | 1/9 | |||
Peng 2012 [12] | R(2002-2007) | HR | HongKong China | 201 | 55 (25-75) | 187/14 | 76/125 | 95/106 | 27/68/83/23 | 197/4/0 | 172/27 | 176/25 | 12.9 | 36.8 | 562.3 |
TACE | 402 | 55 (23-75) | 374/28 | 178/224 | 132/270 | 54/136/166/46 | 389/13/0 | 356/46 | 363/39c
| 12.5 | 36.3 | 598.5 | |||
Liu PH 2014 [22] | R(2002-2012) | HR | Taiwan USA | 108 | 62 ± 15 | 91/17 | NA | 57/51 | NA | 91/17/0 | 50/58 | NA | 0.9 ± 0.9 (mg/dL) | 38 ± 5 | 19,532 ± 55,912 (ng/mL) |
TACE | 108 | 61 ± 14 | 84/24 | NA | 56/52 | NA | 95/13/0 | 49/59 | NA | 1.0 ± 0.6 (mg/dL) | 38 ± 4 | 32,725 ± 138,234 (ng/mL) | |||
Liu K 2014 [17] | R(2003-2010) | HR | China | 41 | 48.7 ± 10.2 | NA | 9.3 ± 2.7 | 41/0 | 12/21/3/0 | 35/6/0 | 32/9 | NA | 28.5 ± 11.0 | 39.2 ± 6.1 | 10/31 |
TACE | 72 | 49.7 ± 10.2 | NA | 10.5 ± 3.6 | 72/0 | 24/32/16/0 | 59/13/0 | 60/12 | NA | 29.3 ± 11.5 | 38.4 ± 5.1 | 16/56 | |||
Ye 2014 [24] | R(2007-2009) | HR | China | 90 | 49.3 ± 10.7 | 81/9 | 6.9 ± 1.6 | 51/39 | 0/66/24/0 | 84/6/0 | 12/78 | NA | NA | NA | 48/42 |
TACE | 86 | 45.6 ± 10.2 | 80/6 | 6.5 ± 2.7 | 32/54 | 0/66/20/0 | 78/8/0 | 18/68 | NA | NA | NA | 38/48 | |||
Lee 2016 [13] | R(2000-2011) | HR | Korea | 40 | 55.0 ± 12.9 | 30/10 | 20/20 | NA | 0/26/14/0 | 35/5/0 | 31/9 | 27/13 | 0.9 ± 0.9 (mg/dL) | 40 ± 0.6 | 10,728 ± 25,073 (ng/mL) |
TACE | 80 | 58.3 ± 10.5 | 67/13 | 10/70 | NA | 0/31/49/0 | 58/22/0 | 54/26 | 73/7 | 1.3 ± 1.3 (mg/dL) | 36 ± 0.5 | 27,302 ± 71,902 (ng/mL) | |||
Zheng 2016 [1] | R(2000-2008) | HR | China | 96 | 51.9 ± 14.3 | 75/21 | 7.9 ± 2.2 | 2.4 ± 1.4 | 25/23/23/25 | 75/21/0 | 86/10 | 82/14 | NA | NA | 1120.6 ± 3930.7 (ng/mL) |
TACE | 134 | 51.6 ± 13.3 | 98/36 | 8.0 ± 2.4 | 2.7 ± 1.8 | 31/32/33/38 | 101/33/0 | 117/17 | 118/16 | NA | NA | 1222.2 ± 2698.1 (ng/mL) | |||
Wang 2016 [11] | R(2002-2014) | HR | HongKong China | 745 | 305/440 (≥50/<50) | 679/66 | 138/607 | 693/52 | 263/351/194/0 | 737/8/0 | 670/75 | 513/232 | 543/202 (<18.8/≥18.8) | 47/698 (<35/≥35) | 274/471 |
TACE | 604 | 319/285 (≥50/<50) | 534/70 | 79/525 | 474/130 | 47/288/269/0 | 567/37/0 | 125/479 | 473/131 | 353/251 (<18.8/≥18.8) | 130/474 (<35/≥35) | 230/374 |
Treatment regimens
Study | TACE | HR | ||
---|---|---|---|---|
Duration and interval | Chemotherapeutic agents | Embolic agents | Methods and procedure | |
Fan 2001 [20] | Median 2 times (ranged 1-4) | 5-fluorouracil (5-Fu) 1000 mg, mitomycin (MMC) 12 to20 mg, cisplatin or carborplatinum 80 mg | Lipiodol 20 ml | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Fan 2003 [19] | Median 2-3 times (ranged 1-7) | 5-fluorouracil (5-Fu) 1000-1500 mg, cisplatin 80-100 mg, mitomycin (MMC) 8 to20 mg or doxorubicin 80 mg | Lipiodol 2-20 ml | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Cheng 2005 [18] | NA | Cisplatin, doxorubicin and mitomycin | Lipiodol | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Fan 2005 [21] | Ranged 1-7 times | 5-fluorouracil (5-Fu) 1000-1500 mg, cisplatin 80-100 mg, mitomycin (MMC) 8-20 mg or epiadriamycin 40-60 mg | Lipiodol 5-20 ml | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Zhou 2011 [25] | Every 1-2 months for 2-5 cycles. | 5-fluorouracil (500 mg /m2) and Adriamycin (30 mg/m2) | Gelatin sponge particles (1 mm3) | Hepatectomy plus thrombectomy |
Peng 2012 [12] | Mean of 2.1 (ranged 1-5) | Carboplatin 300 mg, epirubicin 50 mg and mitomycin C 8 mg | Gelatin sponge particles (1 to 2 mm in diameter) Lipiodol 5 mL | Hepatectomy plus thrombectomy |
Liu PH 2014 [22] | NA | Adriamycin 20–30 mg | Lipiodol 5-10 ml Gelfoam (2–3-mm strips) | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Liu K 2014 [17] | NA | Cisplatin 50-100 mg and epirubicin 20-40 mg | Lipiodol 5-20 ml | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Ye 2014 [24] | 1 month intervals (ranged 1-7) | Doxorubicin 30-50 mg and cisplatinum 50-100 mg | Lipiodol 10-20 ml and gelfoam particles | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Lee 2016 [13] | Every 4 weeks | Doxorubicin 50 mg | Lipiodol | Hepatectomy plus thrombectomy |
Zheng 2016 [1] | Mean of 2.9 (ranged 1–7) | NA | Gelatin sponge | Hepatectomy plus thrombectomy |
Wang 2016 [11] | Intervals of 6 to 8 weeks | Doxorubicin hydrochloride 20-60 mg, and cisplatin 5 mg | Lipiodol 5-30 ml and gelfoam fragments | En-bloc resection, partial hepatectomy or hemihepatectomy Thrombectomy |
Overall survival
Study(year) | Treatments | Patients | Median OS(months) | 6-month(%) | 1-year(%) | 2-year(%) | 3-year(%) | 5-year(%) of Survival rates |
---|---|---|---|---|---|---|---|---|
Fan 2001 [20] | HR | 74 | 12 | NA | 53.9 | NA | 26.9 | 16.6 |
TACE | 18 | 5 | NA | 22.2 | NA | 5.6 | 0 | |
Fan 2003 [19] | HR | 19 | 10.3 | 45.9 | 14.2 | 0 | 0 | NA |
TACE | 41 | 7.1 | 34.2 | 12.2 | 0 | 0 | NA | |
Cheng 2005 [18] | HR | 7 | 8.0 (4.5-11.5) | NA | 14.3 | NA | NA | NA |
TACE | 38 | 5.0 (4.4-5.6) | NA | 10.5 | NA | NA | NA | |
Fan 2005 [21] | HR | 24 | 10.1 | 46.8 | 22.7 | 9.8 | 0 | NA |
TACE | 53 | 7.3 | 34.6 | 11.8 | 0 | 0 | NA | |
Zhou 2011 [25] | HR | 38 | 10 | NA | 47.0 | NA | 22.0 | NA |
TACE | 10 | 7 | NA | 20.0 | NA | 0 | NA | |
Peng 2012 [12] | HR | 201 | 20.0 ± 1.8 | NA | 42.0 | NA | 14.1 | 11.1 |
TACE | 402 | 13.1 ± 0.6 | NA | 37.8 | NA | 7.3 | 0.5 | |
Liu PH 2014 [22] | HR | 108 | 64 | NA | 84 | NA | 69 | 69 |
TACE | 108 | 32 | NA | 71 | NA | 50 | 35 | |
Liu K 2014 [17] | HR | 41 | 21.5 | NA | 70.1 | 40.8 | 16.7 | NA |
TACE | 72 | 13.8 | NA | 44.8 | 17.4 | 7.5 | NA | |
Ye 2014 [24] | HR | 90 | 8.2 | NA | 28 | 20 | 15 | NA |
TACE | 86 | 7.0 | NA | 17.5 | 0 | 0 | NA | |
Lee 2016 [13] | HR | 40 | 19.9 | NA | 64.7 | 58.3 | 49.9 | NA |
TACE | 80 | 6.6 | NA | 46.2 | 15.4 | 7.7 | NA | |
Zheng 2016 [1] | HR | 96 | NA | NA | 86.5 | NA | 60.4 | 33.3 |
TACE | 134 | NA | NA | 77.6 | NA | 47.8 | 20.9 | |
Wang 2016 [11] | HR | 745 | NA | NA | 49.1 | 29.1 | 18.3 | 9.5 |
TACE | 604 | NA | NA | 27.6 | 11.3 | 6.8 | 4.6 |
Subgroup analysis for outcomes of different types of PVTT
Study(year) | Treatment | Type of PVTT | Patients | Median OS(months) | 1-year(%) | 2-year(%) | 3-year(%) | 5-year(%) of Survival rates |
---|---|---|---|---|---|---|---|---|
Fan 2001 [20] | HR | Type II | 58 | 13.0 | 59.7 | NA | 27.4 | 8.8 |
Type III | 16 | 8.0 | 29.4 | NA | 14.3 | 11.1 | ||
TACE | Type II | 12 | 5.0 | 16.7 | NA | 8.3 | 0 | |
Type III | 6 | 5.5 | 33.3 | NA | 0 | 0 | ||
Peng 2012 [12] | HR | Type I | 27 | NA | 81.5 | NA | 51.2 | 37.9 |
Type II | 68 | NA | 46.3 | NA | 17.2 | 17.2 | ||
Type III | 83 | NA | 32.5 | NA | 3.6 | 3.6 | ||
Type IV | 23 | NA | 21.7 | NA | 0 | 0 | ||
TACE | Type I | 64 | NA | 41.1 | NA | 8.9 | 3.6 | |
Type II | 136 | NA | 37.9 | NA | 6.0 | 0 | ||
Type III | 166 | NA | 36.1 | NA | 4.2 | 0 | ||
Type IV | 46 | NA | 30.4 | NA | 4.3 | 0 | ||
Liu K 2014 [17] | HR | Type I | 12 | 30.0 | 100.0 | 66.7 | 30.0 | NA |
Type II | 21 | 18.2 | 66.7 | 32.6 | 0 | NA | ||
Type III | 8 | 8.9 | 25.0 | 0 | 0 | NA | ||
TACE | Type I | 24 | 19.7 | 74.8 | 30.8 | 12.8 | NA | |
Type II | 32 | 10.8 | 25.9 | 9.7 | 0 | NA | ||
Type III | 16 | 7.4 | 25.0 | 0 | 0 | NA | ||
Lee 2016 [13] | HR | Type I | 16 | NA | 71.4 | 54.5 | 54.4 | NA |
Type II | 8 | NA | 35.0 | 0 | 0 | NA | ||
TACE | Type I | 12 | NA | 50.0 | 25.0 | 16.7 | NA | |
Type II | 14 | NA | 35.7 | 7.1 | 0 | NA | ||
Wang 2016 [11] | HR | Type I | 122 | 14.7 (10.7-18.7) | 57.2 | 36.1 | 21.0 | 10.0 |
Type II | 187 | 12.1 (10.0-14.2) | 50.8 | 31.0 | 22.3 | 13.3 | ||
Type III | 171 | 6.2 (4.4-7.9) | 36.3 | 17.4 | 8.2 | 2.6 | ||
TACE | Type I | 45 | 8.7 (4.1-13.3) | 40.0 | 17.3 | 7.3 | 0 | |
Type II | 187 | 5.3 (4.4-6.2) | 25.1 | 9.5 | 5.3 | 4.5 | ||
Type III | 171 | 5.2 (3.7-6.6) | 28.1 | 12.1 | 6.7 | 5.7 |