title: Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis.
abstract: BACKGROUND
  Although transarterial chemoembolization (TACE) has been used extensively for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), no consensus has been reached and an evidence base for practice is lacking. This meta-analysis evaluated the efficacy and safety of TACE for treatment of HCC with PVTT.
  
  
  METHODS
  Ovid Medline, EMBASE, Web of Knowledge, and Cochrane library databases were searched up to August 2012 for controlled trials assessing TACE in patients with PVTT. Data concerning the study design, characteristics of trials, and outcomes were extracted. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using random effects models.
  
  
  RESULTS
  Eight controlled trials involving 1601 HCC patients were included. TACE significantly improved the 6-month (HR, 0.41; 95% CI: 0.32-0.53; z, 6.28; p = 0.000) and 1-year (HR, 0.44; 95% CI: 0.34-0.57; z, 6.22; p = 0.000) overall survival of patients with PVTT compared with conservative treatment. Subgroup analyses showed that TACE was significantly effective in HCC patients whether with main portal vein (MPV) obstruction or with segmental PVTT. Fatal complications were rare, even in patients with MPV obstruction. Temporary liver decompensation and postembolization syndrome occurred frequently. However, they could be treated successfully with conservative treatment.
  
  
  CONCLUSIONS
  TACE, as a safe treatment, has potential for incurring a survival benefit for advanced HCC with PVTT, even with MPV obstruction. Further large randomized controlled trials may be needed to confirm this result.
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. ren.zhenggang@zs-hospital.sh.cn
authors.forename: Tong-Chun
authors.initials: TC
authors.lastname: Xue
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Xie
authors.forename: Lan
authors.initials: L
authors.lastname: Zhang
authors.forename: Xin
authors.initials: X
authors.lastname: Yin
authors.forename: Bo-Heng
authors.initials: BH
authors.lastname: Zhang
authors.forename: Zheng-Gang
authors.initials: ZG
authors.lastname: Ren
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011169:Portal Vein / Q000473:pathology*; D016019:Survival Analysis; D016896:Treatment Outcome