Table 1. Study characteristics: an overview of included studies.
| First author | Journal (Year) | Region | Enrollment period | Study design | No. Pts (TACE / no TACE) | Target population | Timing of TACE | Interval between pre-operative or post-operative TACE and resection |
|---|---|---|---|---|---|---|---|---|
| Adachi E | Cancer (1993) | Japan, Fukuoka | 1981.1–1991.6 | Cohort | 72 (46/26) | Patients with HCC <5 cm in maximum diameter and without portal or hepatic venous invasion and intrahepatic metastases who were thought to be at risk for disease recurrence; >3 years of follow-up after resection. | Pre-operative TACE | Average (range): 33 (5–104) days |
| Cheng HY | Zhonghua Zhong Liu Za Zhi (2005) | China, Shanghai | 1996.6–2001.6 | Retrospective cohort | 1630 (987/643) | HCC who underwent hepatic resection. | Post-operative TACE | 1–2 months |
| Cheng SQ | Zhonghua Zhong Liu Za Zhi (2004) | China, Shanghai | 2000.1–2002.12 | RCT | 39 (23/16) | HCC who underwent hepatic resection. | Post-operative TACE | NA |
| Cheng SQ | Zhonghua Zhong Liu Za Zhi (2005) | China, Shanghai | 2000.1–2003.1 | Retrospective cohort | 27 (20/7) | HCC with PVTT. | Post-operative TACE | NA |
| Chen XH | Zhonghua Yi Xue Za Zhi (2010) | China, Shanghai | 2000.11–2007.12 | Retrospective cohort | 2591 | HCC was divided according to tumor diameter and risk factors for residual tumor. | Post-operative TACE | 1–2 months |
| Chen XP | Dig Surg (2007) | China, Wuhan | 1990.1–2004.12 | Retrospective cohort | 246 (89/157) | Main tumors were centrally located (tumors confined to Couinaud's segments IV, V, and VIII). | Pre-operative TACE | Mean:26 ± 15 days |
| Choi GH | World J Surg (2007) | Korea, Seoul | 1998.3–2005.1 | Retrospective cohort | 273 (120/153) | HCC who underwent curative resection. | Pre-operative TACE | Average (range): 49 (6–174) days |
| Di Carlo V | Hepato-gastroenterology (1998) | Italy, Milano | 1989.3–1997.12 | Cohort | 100 (55/45) | Cirrhotic patients with HCC ≤5cm with unifocal or bifocal tumor lesions. | Pre-operative TACE | Average (range): 53 (45–140) days |
| Gerunda GE | Liver Transpl (2000) | Italy, Padova | 1988–1997.12 | Prospective cohort | 37 (20/17) | HCC candidates for liver surgery. | Post-operative TACE | NA |
| Hanazaki K | J Am Coll Surg (2000) | Japan, Matsumoto | 1983.12–1997.12 | Retrospective cohort | 386 (138/248); 327 (117/210)* | HCC who underwent hepatic resection. | Pre-operative TACE | NA |
| Harada T | Ann Surg (1996) | Japan, Fukuoka | 1982.2–1994.1 | Cohort | 140 (105/35); 131 (98/33)* | HCC who underwent hepatic resection. | Pre-operative TACE | Average (range): 72.9 ± 52.0 (21–327) days |
| Izumi R | Hepatology (1994) | Japan, Kanazawa | 1987.1–1992.8 | RCT | 50 (23/27) | Patients with invasive HCC with vascular invasion and/or intrahepatic metastasis, who underwent curative hepatic resection in which all the macroscopic HCC was removed during surgery. | Post-operative TACE | Mean (range): 38.4 days (21–84) |
| Jianyong L | Ann Hepatol (2014) | China, Chengdu | 2005.6–2008.8 | Retrospective cohort | 656 (183/405) | HCC who underwent curative resection. | Pre-operative TACE | Mean: 135 days |
| Kaibori M | Anticancer Research (2006) | Japan, Osaka | 1992.2–2005.2 | Cohort | 245 (115/128) | HCC who underwent curative hepatectomy was divided according to the preoperative ICGR15. | Pre-operative TACE | NA |
| Kaibori M | Dig Dis Sci (2012) | Japan, Osaka | 2004.1–2007.6 | RCT | 124 (81/43) | HCC who underwent curative resection. | Pre-operative TACE | Mean: 21.2 ± 10.8 days in selective TACE group; 23.0 ± 13.2 days in whole-liver chemolipiodolization group |
| Kang JY | Korean J Hepatol (2010) | Korea, Seoul | 1997.1–2007.12 | Case-control | 96 (32/64) | HCC who underwent hepatic resection. | Pre-operative TACE | Mean:102.9 ± 130.7 days |
| Kim IS | Aliment Pharmacol Ther (2008) | Korea, Seoul | 1995.1–2000.12 | Retrospective cohort | 334 (97/237) | HCC who underwent curative resection. | Pre-operative TACE | Median (range):4 weeks (1–16) |
| Kishi Y | Hepato-gastroenterology (2012) | Japan, Tokyo | 1994.2–2008.10 | Cohort | 227 (69/158) | HCC who underwent curative resection. | Pre-operative TACE | Within 3 months |
| Lee KT | J Surg Oncol (2009) | China, Taiwan | 2000.1–2006.6 | Retrospective cohort | 350 (114/236) | HCC who underwent hepatic resection. | Post-operative TACE | Median (range):66.5 ± 110.9 days (2–286) |
| Li F | Ir J Med Sci (2014) | China, Tianjin | 2006.2–2009.5 | Retrospective cohort | 60 (26/34) | HBV-related HCC, no prior treatments for HCC except hepatic curative resection treatment, BCLC stage B, Child-Pugh stage A or B, HBsAg positive, no distant metastasis, and no contraindication for laparotomy. | Post-operative TACE | 1 month |
| Li JQ | J Cancer Res Clin Oncol (1995) | China, Guangzhou | 1990.4–1993.12 | RCT | 140 (70/70) | HCC patients undergoing radical (n = 94) and palliative resection (n = 46). | Post-operative TACE | 3–4 weeks |
| Li KW | Hepato-gastroenterology (2012) | China, Chengdu | 2005.7–2010.8 | Retrospective cohort | 76 (35/41) | HCC, no lymph node involvement and distant metastasis, no macroscopic venous invasion. | Post-operative TACE | 4–6 weeks |
| Li Q | Dig Surg (2006) | China, Tianjin | 1998.1–2001.1 | RCT | 84 (39/45) | HCC, no previous management, solitary or multiple tumors mainly located in one lobe of the liver, no distant metastases, Child-Pugh stage A or B. | Post-operative TACE | 4 weeks |
| Li Q | World J Surg (2006) | China, Tianjin | 1998.1–2001.1 | RCT | 72 (35/37) | HCC, no previous management, tumor thrombus in the first branch and/or main trunk of the portal vein, solitary or multiple tumors mainly located in one lobe of the liver, no distant metastasis, Child-Pugh stage A or B, no contraindication for laparotomy. | Post-operative TACE | 4 weeks |
| Liu YJ | Zhonghua Fang She Xue Za Zhi (2010) | China, Beijing | 1997.1–2009.12 | Retrospective cohort | 386 (230/156) | HCC who underwent hepatic resection. | Pre-and/or post-operative TACE | Pre-operative TACE: Median (range): 7 weeks (l-34); Mean: 7 ± 3 Post-operative TACE: Median (range): 8 weeks (2–124); Mean: 9 ± 2 |
| Lu CD | World J Surg (1999) | China, Hangzhou; Japan, Fukui | 1988–1994 | Retrospective cohort | 120 (44/76) | HCC patients excluding tumor diameter ≤2 cm, hepatectomy-related mortality, portal vein or hepatic vein tumor thrombus identified by imaging or operation, and lymph node or extrahepatic metastasis. | Pre-operative TACE | Tumors 2–8 cm in diameter: 29 ± 10 days (range: 9–42 days); Tumors >8 cm in diameter: 8 ± 75 days (range: 30–312 days) |
| Majno PE | Ann Surg (1997) | France, Villejuif | 1985.1–1995.12 | Retrospective cohort | 76 (49/27) | Histologically confirmed HCC associated with cirrhosis who underwent liver resection. | Pre-operative TACE | NA |
| Nagasue N | Surgery (1989) | Japan, Hiroshima | 1980.1–1987.12 | Retrospective cohort | 138 (31/107) | Primary HCC who underwent liver resection with total extirpation of tumor. | Pre-operative TACE | Mean:130 days |
| Nishikawa H | Int J Oncol (2013) | Japan, Osaka | 2004.1–2012.6 | Retrospective cohort | 235 (110/125) | Treatment-naïve HCC who underwent hepatic resection. | Pre-operative TACE | NA |
| Ochiai T | Hepato-gastroenterology (2003) | Japan, Shiga | 1978.10–1994.4 | Retrospective cohort | 148 (100/48) | Solitary HCC who underwent hepatic resection. | Pre-operative TACE | Average:35.7 days |
| Park JH | Cardiovasc Intervent Radiol (1993) | Korea, Seoul | 1987.2–1991.9 | Retrospective cohort | 65 (45/20) | Patients who developed recurrent HCC after resection underwent TACE between February 1987 and September 1991. | Pre-operative TACE | NA |
| Paye F | Arch Surg (1998) | France, Clichy | 1986.12–1992.1 | Case-control | 48 (24/24) | HCC who underwent resection. | Pre-operative TACE | Mean:45 ± 40 days |
| Peng BG | Am J Surg (2009) | China, Guangzhou | 1996.1–2006.12 | RCT | 104 (51/53)$ | HCC with PVTT. | Post-operative TACE | NA |
| Ren ZG | World J Gastroenterol (2004) | China, Shanghai | 1995.1–1998.12 | Retrospective case-control | 549 (185/364) | All HCC lesions were removed, no lymph node involvement, no distant metastasis. | Post-operative TACE | 2 months |
| Sasaki A | Eur J Surg Oncol (2006) | Japan, Beppu | 1982.7–2003.4 | Retrospective cohort | 239 (109/126) | HCC who underwent curative resection. | Pre-operative TACE | Mean: 33.1 days; Median (range): 18.0 days (2–276) |
| Shi HY | J Surg Oncol (2014) | China, Taiwan | 1996–2009 | Propensity score analysis | 1296 (648/648) | HCC who underwent liver resection. | Pre-operative TACE | NA |
| Sugo H | World J Surg (2003) | Japan, Tokyo | 1979.9–2000.3 | Retrospective cohort | 227 (146/81) | HCC who underwent liver resection. | Pre-operative TACE | NA |
| Tang QH | Academic J Second Military Medical University (2009) | China, Shanghai | 2001.7–2003.12 | RCT | 108 (52/56) | Resectable large HCC (≥5 cm). | Pre-operative TACE | 5–8 weeks |
| Uchida M | World J Surg (1996) | Japan, Izumo | 1986.4–1991.11 | Retrospective cohort | 128 (60/68) | HCC who underwent curative resection of the tumor. | Pre-operative TACE | Mean:42.3 ± 28.4 days |
| Wang QX | Zhonghua Wai Ke Za Zhi (2009) | China, Shanghai | 2004.1–2007.6 | Retrospective cohort | 260 (104/156) | HCC who underwent curative resection. | Post-operative TACE | Mean:1.7 months (1–6) |
| Wang TH | Chinese J Cancer Prevention and Treatment (2010) | China, Shanghai | 1997.1–2007.12 | Retrospective cohort | 176 (51/125) | Huge HCC who had undergone surgical resection. | Pre-operative TACE | Mean:60 days (18–135) |
| Wu CC | Br J Surg (1995) | China, Taiwan | 1983.1–1991.12 | RCT | 52 (24/28); 49 (23/26)# | Resectable large HCC. | Pre-operative TACE | Mean:1.8±0.6 weeks (range: 1.0–3.0) |
| Xiao EH | Zhonghua Zhong Liu Za Zhi (2005) | China, Changsha | 1992.2–1999.2 | Cohort | 139 (81/58) | Histologically confirmed HCC who underwent liver resection. | Pre-operative TACE | NA |
| Xiao YP | World Chinese J Digestology (2012) | China, Guangxi | 2005.10–2010.10 | Retrospective cohort | 120 (88/32) | HCC who underwent curative resection; with high-risk factor of recurrence: 1) vascular tumor thrombus; 2) multiple nodules; 3) pre-operative AFP >200 μg/L; 4) large HCC (diameter >5 cm). | Post-operative TACE | 3–6 weeks |
| Xi T | Hepato-gastroenterology (2012) | China, Shanghai | 1996.2–2001.9 | Cohort | 721 (145/576) | HCC who underwent R0 partial hepatectomy. | Post-operative TACE | 4–9 weeks |
| Xu F | Academic J Second Military Medical University (2012) | China, Shanghai | 2008.9–2009.12 | RCT | 117 (59/58) | Small HCC (diameter ≤5 cm), single nodule, no vascular invasion, no residual tumor, no extrahepatic metastasis, Child-Pugh score ≤7. | Post-operative TACE | 1 month |
| Xu F | Academic J Second Military Medical University (2012) | China, Shanghai | 2008.1–2008.12 | Prospective cohort | 104 (56/48) | HCC who under curative resection; number of tumor < 4; no extrahepatic spread; no residual tumor. | Post-operative TACE | 1 month |
| Yamasaki S | Jpn J Cancer Res (1996) | Japan, Tokyo | 1987.7–1989.12 | RCT | 115 (57/58) | Untreated non-recurrent HCC; age ≤65. | Pre-operative TACE | NA |
| Yanaga K | HPB (2014) | Japan | 2000.1–2013.10 | Cohort | 213 (37/176) | HCC who underwent liver resection. | Pre-operative TACE | NA |
| Yang PS | Liver Transpl (2010) | China, Taiwan | 1995.5–2009.6 | Cohort | 241 (206/35) | HCC with Milan criteria who underwent liver resection. | Pre-operative TACE | NA |
| Yan Q | Chin Med J (2013) | China, Hangzhou | 2005.1–2008.6 | Cohort | 44 (19/25) | HBV-related HCC who underwent local and regional liver resection, single tumor < 8 cm; ≤3 tumor < 3 cm; no residual tumor; no distant metastasis. | Post-operative TACE | 2 months |
| Yu ZP | J Pract Med (2009) | China, Wenzhou | 2000.1–2005.6 | RCT | 97 (50/47) | HCC who underwent curative resection. | Post-operative TACE | Within 2 weeks (n=36); beyond 2 weeks (n=14) |
| Zhang Z | Cancer (2000) | China, Shanghai | 1990.1–1995.12 | Retrospective cohort | 1457 (1275/182) | Resectable HCC. | Pre-operative TACE | From 15 days to 8 months |
| Zhong C | J Cancer Res Clin Oncol (2009) | China, Guangzhou | 2001.1–2004.3 | RCT | 115 (57/58) | Stage IIIA HCC (multiple tumors >5 cm or tumor involving a major branch of the portal or hepatic vein(s) (UICC TNM staging system, sixth edition)). | Post-operative TACE | 4-6 weeks |
| Zhou WP | Ann Surg (2009) | China, Shanghai | 2001.7–2003.12 | RCT | 108 (52/56) | Resectable large HCC (≥5 cm). | Pre-operative TACE | 5-8 weeks |
Abbreviations: HCC, hepatocellular carcinoma; NA, not available; PVTT, portal vein tumor thrombus; RCT, randomized controlled trial; TACE, transarterial chemoembolization.
Notes:
*
patients who were finally included in the disease-free survival analysis.
$
patients lost to follow-up were excluded from the survival analysis.
#
patients who were finally included in the survival analysis.