Background: Hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) has a poor prognosis, and the benefits of neoadjuvant therapy are unclear. This systematic review and meta-analysis aim to evaluate the impact of neoadjuvant treatment (NAT) followed by surgery versus surgery alone on survival outcomes.Methods:A PRISMA-compliant systematic review was conducted by searching the OVID databases Embase, Medline, PubMed, and Scopus for English-language comparative studies of resectable HCC with PVTT, up to 23 January 2025. Two reviewers independently screened, extracted data, and assessed risk of bias (ROBINS-I/ROB2). Hazard ratios (HRs) for overall survival (OS) and recurrence-free survival (RFS) were pooled for meta-analysis.Results:Seven studies (2015–2024, five retrospective cohorts, one non-randomised comparative, one RCT) included 621 patients. The pooled analysis demonstrated that NAT followed by surgery was associated with a significantly improved OS (HR: 0.48, 95% CI: 0.295–0.67,p-value < 0.001, I2= 0.00) and improved RFS (HR: 0.4, 95% CI: 0.2–0.58,p-value < 0.001, I2= 0.00).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. Current evidence is largely non-randomised and HBV-endemic, warranting prospective validation in aetiologically diverse cohorts, including Western ones.
背景：肝细胞癌（HCC）伴门静脉癌栓（PVTT）预后较差，且新辅助治疗的获益尚不明确。本系统综述与荟萃分析旨在评估新辅助治疗联合手术与单纯手术对生存结局的影响。
方法：遵循PRISMA指南进行系统综述，检索OVID数据库中的Embase、Medline、PubMed及Scopus，收集截至2025年1月23日关于可切除性HCC伴PVTT的英文比较研究。由两位研究者独立筛选文献、提取数据并评估偏倚风险（ROBINS-I/ROB2）。对总生存期（OS）和无复发生存期（RFS）的风险比（HR）进行荟萃分析合并。
结果：共纳入7项研究（2015–2024年，包括5项回顾性队列研究、1项非随机比较研究和1项随机对照试验），涉及621例患者。合并分析显示，新辅助治疗后手术与显著改善的OS（HR：0.48，95% CI：0.295–0.67，p值 < 0.001，I²= 0.00）及RFS（HR：0.4，95% CI：0.2–0.58，p值 < 0.001，I²= 0.00）相关。
结论：对于HCC伴PVTT患者，术前新辅助治疗能显著提高总生存率和无复发生存率。这些发现支持采用多模式治疗策略。当前证据主要基于非随机研究和乙型肝炎流行地区的数据，需要在包括西方人群在内的不同病因学队列中进行前瞻性验证。
肿瘤(癌症)患者之家