Impacts of liver resection with neoadjuvant treatment versus surgery alone in hepatocellular carcinoma with portal vein tumour thrombosis: a systematic review and meta-analysis
File(s)
Accepted version
Author(s)
Rajagopal, Poyyamozhi
Vijayagopal, Kesav Aditya
Kannan, Shanmuga S
Shetty, Shraddha
Pai, Madhava
Type
Journal Article
Abstract
Background/Objectives: Hepatocellular carcinoma (HCC) with Portal Vein Tumour Thrombosis (PVTT) is an advanced-stage (BCLC-C) disease, typically managed with systemic therapy. While surgical resection is increasingly offered, the role of neoadjuvant
treatments (NAT) remains unquantified. This systematic review and meta-analysis evaluate the impact of NAT followed by surgery versus surgery alone on survival outcomes for patients with HCC with PVTT. Methods: A PRISMA-compliant systematic review was conducted by searching OVID- Embase, Medline, PubMed, and Scopus databases up to January 23, 2025. Two independent authors screened articles. Risks of bias were assessed using the ROBINS-I tool for non-randomised studies and the Cochrane risk of bias (ROB-
2) tool for randomised controlled trials. The methodological quality was evaluated using
the Newcastle–Ottawa Scale (NOS). Hazard ratios (HRs) for overall survival (OS) and Recurrence-free survival (RFS) were pooled for meta-analysis. Results: Seven studies met the inclusion criteria. The pooled analysis demonstrated that NAT followed by surgery was associated with a significantly improved overall survival (HR: 0.48, 95% CI: 0.295-0.67, p-value <0.001, I2 = 0.00) and improved recurrence-free survival (RFS) (HR: 0.4, 95% CI: 0.2-0.58, p-value <0.001, I2 = 0.00) compared to direct-to-surgery. Conclusions: For patients with HCC and an associated PVTT, neoadjuvant treatment before surgery significantly improves both overall and recurrence-free survival. These findings support a multimodal approach. Future multicenter randomised controlled trials may be needed to identify optimal NAT strategies in this patient population.
treatments (NAT) remains unquantified. This systematic review and meta-analysis evaluate the impact of NAT followed by surgery versus surgery alone on survival outcomes for patients with HCC with PVTT. Methods: A PRISMA-compliant systematic review was conducted by searching OVID- Embase, Medline, PubMed, and Scopus databases up to January 23, 2025. Two independent authors screened articles. Risks of bias were assessed using the ROBINS-I tool for non-randomised studies and the Cochrane risk of bias (ROB-
2) tool for randomised controlled trials. The methodological quality was evaluated using
the Newcastle–Ottawa Scale (NOS). Hazard ratios (HRs) for overall survival (OS) and Recurrence-free survival (RFS) were pooled for meta-analysis. Results: Seven studies met the inclusion criteria. The pooled analysis demonstrated that NAT followed by surgery was associated with a significantly improved overall survival (HR: 0.48, 95% CI: 0.295-0.67, p-value <0.001, I2 = 0.00) and improved recurrence-free survival (RFS) (HR: 0.4, 95% CI: 0.2-0.58, p-value <0.001, I2 = 0.00) compared to direct-to-surgery. Conclusions: For patients with HCC and an associated PVTT, neoadjuvant treatment before surgery significantly improves both overall and recurrence-free survival. These findings support a multimodal approach. Future multicenter randomised controlled trials may be needed to identify optimal NAT strategies in this patient population.
Date Acceptance
2026-01-13
Citation
Cancers
ISSN
2072-6694
Publisher
MDPI AG
Journal / Book Title
Cancers
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted
Date Publish Online
2026-01-16