title: Transarterial chemoembolization in hepatocellular carcinoma with vascular invasion or extrahepatic metastasis: A systematic review.
abstract: OBJECTIVE
  Advanced hepatocellular carcinoma (HCC) with vascular invasion or extrahepatic metastasis has been considered a contraindication for transarterial chemoembolization (TACE) treatment according to Barcelona Clinic Liver Cancer (BCLC) staging classification. However, real clinical practice varies among different countries. In recent years another opinion has been developing that considers that TACE can be safely performed in advanced HCC patients.
  
  
  METHODS
  All studies on the efficacy of TACE for patients with advanced HCC were identified via the PubMed database. The primary items were TACE and HCC.
  
  
  RESULTS
  We identified 15 studies in the treatment of TACE in advanced HCC patients. Most adverse events reported were treated successfully and in these studies there were no procedure-related deaths within 4 weeks of the TACE treatment. Four controlled studies reported that TACE increased survival rate and prolonged overall survival compared with conservative management. The most frequent prognostic factors were liver function and the degree of portal vein tumor thrombosis.
  
  
  CONCLUSIONS
  TACE can be safely performed in advanced HCC patients with vascular invasion or extrahepatic spread and may improve their overall survival. Patients with portal vein branch invasion and well-preserved liver function seemed to derive optimal benefit from treatment with TACE. Further studies are needed to provide strong evidence of the efficacy of TACE for advanced HCC patients to update the BCLC staging system.
authors.affiliation: Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Guohong
authors.initials: G
authors.lastname: Cai
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.forename: Yongping
authors.initials: Y
authors.lastname: Li
authors.forename: Daiming
authors.initials: D
authors.lastname: Fan
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000628:therapy*; D009362:Neoplasm Metastasis; D016896:Treatment Outcome
keywords: advanced hepatocellular carcinoma; transarterial chemoembolization; treatment