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Objective <p>This study aimed to compare survival outcomes of neoadjuvant therapy followed by surgery (Neo + Surgery) with surgery alone (Surgery) in patients with resectable hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).</p> Methods <p>A comprehensive search of online databases was performed from January 1990 to May 2025. Relative outcomes of RFS and OS were synthesized. The perioperative outcomes were analyzed. A single-arm meta-analysis and subgroup analysis were conducted.</p> Results <p>Eight studies involving 1024 participants (417 in the Neo + surgery group vs. 607 in the Surgery group) were included. The Neo + surgery group showed a significant advantage over the Surgery group in terms of the overall hazard ratio (HR) for RFS (HR = 0.42, 95% CI: 0.33 to 0.52, <i>P</i> &lt; 0.001) and OS (HR = 0.47, 95% CI: 0.39 to 0.56, <i>P</i> &lt; 0.001). The pooled proportion of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), severe adverse events (AEs) rate, and surgical contraindication rate were 9.1% (95% CI: 1.6%-20.9%, <i>P</i> = 0.0028), 36.9% (95%CI: 25.4%-49.1%, <i>P</i> &lt; 0.001), 43.5% (95%CI: 26.8%-61.0%, <i>P</i> &lt; 0.001), 6.3% (95% CI: 1.7%-12.9%, <i>P</i> &lt; 0.001), 18.4% (95% CI: 5.3%-36.3%, <i>P</i> &lt; 0.001), and 15.9% (95%CI: 8.8%-24.5%, <i>P</i> &lt; 0.001), respectively. No significant differences were observed between the Neo + surgery group and the Surgery group regarding perioperative outcomes.</p> Conclusion <p>The meta-analysis confirms that Neo + Surgery is superior to Surgery in terms of RFS and OS for patients with resectable HCC and PVTT. Our findings suggest that neoadjuvant therapy may offer clinical benefit and should be considered in selected patients with resectable HCC and PVTT.</p>

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Neoadjuvant therapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: an updated systematic review with meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Weidong Lin,
  • Kunpeng Wang,
  • Chenyi Pan,
  • Lei Ma

摘要

Objective

This study aimed to compare survival outcomes of neoadjuvant therapy followed by surgery (Neo + Surgery) with surgery alone (Surgery) in patients with resectable hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).

Methods

A comprehensive search of online databases was performed from January 1990 to May 2025. Relative outcomes of RFS and OS were synthesized. The perioperative outcomes were analyzed. A single-arm meta-analysis and subgroup analysis were conducted.

Results

Eight studies involving 1024 participants (417 in the Neo + surgery group vs. 607 in the Surgery group) were included. The Neo + surgery group showed a significant advantage over the Surgery group in terms of the overall hazard ratio (HR) for RFS (HR = 0.42, 95% CI: 0.33 to 0.52, P < 0.001) and OS (HR = 0.47, 95% CI: 0.39 to 0.56, P < 0.001). The pooled proportion of complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), severe adverse events (AEs) rate, and surgical contraindication rate were 9.1% (95% CI: 1.6%-20.9%, P = 0.0028), 36.9% (95%CI: 25.4%-49.1%, P < 0.001), 43.5% (95%CI: 26.8%-61.0%, P < 0.001), 6.3% (95% CI: 1.7%-12.9%, P < 0.001), 18.4% (95% CI: 5.3%-36.3%, P < 0.001), and 15.9% (95%CI: 8.8%-24.5%, P < 0.001), respectively. No significant differences were observed between the Neo + surgery group and the Surgery group regarding perioperative outcomes.

Conclusion

The meta-analysis confirms that Neo + Surgery is superior to Surgery in terms of RFS and OS for patients with resectable HCC and PVTT. Our findings suggest that neoadjuvant therapy may offer clinical benefit and should be considered in selected patients with resectable HCC and PVTT.