The effectiveness and safety of therapies for hepatocellular carcinoma with tumor thrombus in the hepatic vein, inferior vena cave and/or right atrium: a systematic review and single-arm meta-analysis

This review evaluates the efficacy and safety of therapies for hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus (HVTT), inferior vena cava tumor thrombus (IVCTT), and/or right atrium tumor thrombus (RATT). A systematic review of PubMed, EMBASE, Cochrane Library, and Wanfang databases was conducted for literatures in this topic up to 22 August 2024, focusing on overall survival (OS), progression -free survival (PFS), and adverse reactions. Seven studies involving 453 patients were analyzed. The therapeutic strategies included surgery alone, local ± systemic therapy, and surgery with adjuvant therapy. The pooled 1-, 3-, and 5-year OS rates for all patients were 63.3% (95% CI 52.7%-73.9%), 21.6% (95% CI 4.9%-38.2%), and 8.3% (95% CI 2.9%-13.8%), respectively. Surgery with adjuvant therapy achieved the highest 1-year OS, while local ± systemic therapy led to the best 5-year OS. The pooled 1-, 3-, and 5-year PFS rates for all patients were 56.8% (95% CI 45.2%-68.4%), 9.4% (95% CI 0.0%-20.0%), and 1.6% (95% CI 0.0%-3.8%), respectively. Surgery alone frequently had adverse reactions of ascites and pleural effusion, the local ± systemic therapy frequently resulted in hepatic dysfunction and platelet abnormalities, and surgery and adjuvant therapy was frequently accompanied by peritoneal abscess. Local ± systemic therapy provided the best long-term OS and manageable complications among these three therapeutic strategies for HCC with HVTT, IVCTT, and/or RATT. PROSPERO, (CRD42024573152).