Comparing Effectiveness of Multidisciplinary Treatment Strategies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Systematic Review and Network Meta-Analysis

Background: Several multidisciplinary treatment strategies are now available to treat hepatocellular carcinoma (HCC) and portal vein tumour thrombus (PVTT). However, most of these studies were not powered to test the differences in overall survival (OS). Methods: The PubMed, Cochrane Library, Web of Science and Embase were searched to identify both the direct and indirect evidence for these treatments on patients with HCC and PVTT up to December 31, 2017. A Bayesian random-effects model was used to combine direct with indirect evidence. Results: After screening 1675 citations, 54 trials included 11311 participants and 8 multidisciplinary treatments. The tests of inconsistency and heterogeneity for the network meta-analysis showed the P-values of global inconsistency to range from 0.4012 to 0.6972, and the I2 values to range from 0% to 7% for the 1-, 2-, 3- and 5-year overall survival (OS) rates. After adjusting the network model by Bayesian meta-analysis with clinical variables, a stable ranking of eight treatments was achieved. The results showed that patients who received Sorafenib (SURCA=35.1) was not better than the other treatments. Comprehensive treatments based on surgery (CST) had better OS rates than patients who received other treatments (SURCA =89.6 and the odds ratio (OR) to range from 1.39 to 108.44). Conclusion: CST significantly improved OS when compared with sorafenib and other multidisciplinary treatments, especially in selected HCC patients with PVTT limited to a first-order branch or above of the main portal vein, and with good liver function. Funding Statement: This work is supported by these funding sources as following: the Key Project of Natural Science Foundation of China (No: 81730097); the grants of the Science Fund for Creative Research Groups (No: 81521091); Chang Jiang Scholars Program (2013) of the China Ministry of Education; the National Key Basic Research Program “973 project” (No: 2015CB554000); the National Natural Science Foundation of China (No: 81602523 and No: 81702335) Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study has been registered with PROSPERO under the number CRD42018104670.