For patients with hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT), local therapeutic options include surgery and external beam radiation therapy (EBRT). For a study, researchers sought to assess the viability and efficacy of different therapeutic approaches.

Up to April 2021, the databases of PubMed, Medline, Embase, and Cochrane Library were thoroughly searched. The patients’ overall survival (OS) was the main outcome, and the negative consequences of the therapy were also looked at.

This meta-analysis comprised 59 studies totaling 9,525 patients with HCC and PVT. The remaining trials were single-arm studies or studies with comparison groups other than surgery or EBRT. All studies were non-randomized series, including seven comparative studies. Child-Pugh class A rates were pooled at 74.6% and 95.3% in the EBRT and surgical arms, respectively, while major PVT rates were pooled at 40.7% and 15.5% in the same arms, respectively (P<0.001). The EBRT arm’s combined 1- and 2-year OS rates were 44.1% (95% CI: 40.3-48.0) and 21.7% (95% CI: 18.9-24.8), respectively. Pooled 1- and 2-year OS rates were 59.9% (95% CI: 48.9-70.1) and 30.5% (95% CI: 15.2-51.8), respectively, in the subset of EBRT trials without major PVT. The correlation rates were 62.8% (95% CI: 55.0-70.0) and 42.5% (95% CI: 34.4-51.0), respectively, in the surgical arm. The pooled 1- and 2-year OS rates of the surgical arm were much higher than those of the EBRT arm (Ps< 0.001), and they did not differ significantly from those of the EBRT subgroup without major PVT (P=0.762 and 0.353, respectively). The 1- and 2-year OS rates in trials with surgery combined with EBRT were 77.1% (95% CI: 69.6-83.2) and 45.4% (95% CI: 19.8-73.7), respectively. Depending on the kind, the pooled rates of grade ≥3 toxicities varied from 1.8 to 4.3%.

While EBRT was a viable option for patients, even those with poor clinical characteristics, surgery resulted in a positive survival outcome. To assess whether there was a chance of enhancing the clinical results of surgery combined with EBRT, more research was required.