Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Int J Cancer. 2015 Mar 15;136(6):E751-9. doi: 10.1002/ijc.29203. Epub 2014 Sep 19.
Numerous studies have investigated the effects of adjuvant chemotherapy for primary hepatocellular carcinoma (HCC) patients. We conducted this analysis to evaluate the efficacy of adjuvant chemotherapy in HCC patients after hepatectomy. PubMed/MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies. The major endpoints were overall survival (OS) and disease-free survival (DFS). The pooled odds ratio (OR) was calculated using a random-effects model to summarize the results. In the meta-analysis of 13 randomized control trials (RCTs) and 35 observational studies with 4747 patients, hepatectomy plus adjuvant chemotherapy showed superiority over hepatectomy alone in 1-year DFS (OR = 1.86, 1.38-2.51, p < 0.001), 3-year DFS (OR = 2.37, 1.73-3.24, p < 0.001) and 5-year DFS (OR = 1.99, 1.55-2.55, p < 0.001), as well as 1-year OS (OR = 2.16, 95% confidence interval 1.75-2.68, p < 0.001), 3-year OS (OR = 1.77, 1.48-2.13, p < 0.001) and 5-year OS (OR = 1.92, 1.44-2.56, p < 0.001). Subgroup and sensitivity analysis revealed that only adjuvant TACE had significant survival benefits. The meta-analysis of studies involving patients with portal vein tumor thrombus (PVTT), but not other factors related to recurrence risk, revealed favorable outcomes of the Treatment arm over the Control arm. The present study shows that adjuvant chemotherapy can improve outcomes for HCC patients. The benefits of adjuvant TACE have been confirmed whereas the effects of other adjuvant chemotherapy modalities remain uncertain. Adjuvant chemotherapy is likely to be more applicable to certain patient populations for instance those with PVTT, but further research in identifying these patient factors is of importance for tailoring adjuvant therapies to individual patients in the future.
大量研究调查了辅助化疗对原发性肝细胞癌 (HCC) 患者的影响。我们进行了这项分析，以评估辅助化疗对 HCC 患者肝切除术后的疗效。我们检索了 PubMed/MEDLINE、EMBASE、Cochrane 及其他数据库，以获取合格的研究。主要终点是总生存 (OS) 和无病生存 (DFS)。使用随机效应模型计算汇总结果的合并优势比 (OR)。在对 13 项随机对照试验 (RCT) 和 35 项观察性研究的荟萃分析中，有 4747 例患者接受了肝切除术加辅助化疗，与单纯肝切除术相比，1 年 DFS (OR = 1.86，1.38-2.51，p < 0.001)、3 年 DFS (OR = 2.37，1.73-3.24，p < 0.001)和 5 年 DFS (OR = 1.99，1.55-2.55，p < 0.001)均有优势，1 年 OS (OR = 2.16，95%置信区间 1.75-2.68，p < 0.001)、3 年 OS (OR = 1.77，1.48-2.13，p < 0.001)和 5 年 OS (OR = 1.92，1.44-2.56，p < 0.001)。亚组和敏感性分析表明，只有辅助 TACE 具有显著的生存获益。涉及门静脉癌栓 (PVTT) 患者的研究的荟萃分析，而不涉及其他与复发风险相关的因素，显示治疗组的结局优于对照组。本研究表明辅助化疗可以改善 HCC 患者的预后。辅助 TACE 的获益已得到证实，而其他辅助化疗方式的效果仍不确定。辅助化疗可能更适用于某些患者人群，例如那些有 PVTT 的患者，但进一步研究确定这些患者因素对于未来为个体患者制定辅助治疗方案很重要。
