Effect of neoadjuvant transarterial chemoembolization followed by resection versus upfront liver resection on the survival of single large hepatocellular carcinoma patients: A systematic review and meta-analysis

Backgrounds/Aims: The efficacy of neoadjuvant transarterial chemoembolization (N−TACE) in resectable hepatocellular carcinoma (HCC) remains open to debate. While N−TACE may reduce tumor size, its impact on long-term outcomes is inconclusive. Methods: This meta-analysis reviewed studies on N−TACE before surgical resection vs. liver resection (LR) single large hepatocellular carcinoma (SLHCC) up to March 2023 from four online databases. Results: Five studies with 1,556 patients were analyzed. No significant differences between N−TACE and LR groups were observed in 1-, 3-, or 5-year overall survival (OS) and disease-free survival (DFS). No significant differences were noted in intraoperative blood loss between groups. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N−TACE (combination group), and better 1-year OS in the LR group with single-agent chemotherapy N−TACE (single-agent group). Five-year DFS favored LR in the single-agent group, and N−TACE in the combination group. Conclusions: Managing SLHCC requires intricate considerations, and the treatment strategies for this challenging subgroup of HCC need to be improved. The influence of N−TACE on long-term survival depends on the specific chemotherapy regimen employed, and its impact on intraoperative blood loss in SLHCC appears limited.