Liu Wei, Zhou Jian-Guo, Sun Yi, Zhang Lei, Xing Bao-Cai
Hepatopancreatobiliary Surgery Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, No. 52, Fu-Cheng-Lu Street, Beijing, 100142, People's Republic of China.
J Gastrointest Surg. 2015 Jul;19(7):1271-80. doi: 10.1007/s11605-015-2811-6. Epub 2015 May 6.
Hepatic resection has been increasingly performed in patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the current evidence supporting its efficacy remains controversial. The aim of this systematic review was to investigate the long-term survival and safety of hepatic resection compared to transarterial chemoembolization (TACE) alone for BCLC stage B HCC.
Eligible trials that compared hepatic resection with TACE alone for intermediate HCC were identified from the Embase, PubMed, Web of Science, and Cochrane databases. The study outcomes included overall survival (OS) rate and treatment-related complication rate. Hazard ratios (HRs) with a 95% confidence interval were used to measure the pooled effect according to a random-effects or fixed-effects model, depending on the heterogeneity among the included studies. The heterogeneity among these trials statistically was evaluated using the χ(2) and I (2) tests. Sensitivity analyses were also performed.
A total of 9 studies containing 4958 patients were included. The comparison between hepatic resection and TACE revealed a pooled HR for 3-year OS of 0.403 (95% CI 0.364-0.446, p = 0.000; I (2) = 0 %, p = 0.643) and a pooled HR for 5-year OS of 0.433 (95% CI 0.394-0.475, p = 0.000; I (2) = 0%, p = 0.468). An AFP level >400 ng/ml and being HBV-positive were factors significantly correlated with overall survival. For treatment-related complications, the overall odds ratio (OR) for hepatic resection versus TACE was 0.990 (95% CI 0.934-1.049; p = 0.728; I (2) = 64.5%, p = 0.060).
Hepatic resection likely improved overall survival compared with TACE alone in BCLC stage B HCC patients, but did not increase the incidence of treatment-related complications. An AFP level >400 ng/ml and HBV positivity were significantly correlated with poor OS.
巴塞罗那临床肝癌（BCLC）分期为B期的肝细胞癌（HCC）患者接受肝切除术的情况日益增多，但目前支持其疗效的证据仍存在争议。本系统评价的目的是研究与单纯经动脉化疗栓塞术（TACE）相比，肝切除术治疗BCLC分期为B期HCC的长期生存情况和安全性。
从Embase、PubMed、科学网和Cochrane数据库中检索比较肝切除术与单纯TACE治疗中期HCC的符合条件的试验。研究结局包括总生存率（OS）和治疗相关并发症发生率。根据随机效应或固定效应模型，使用95%置信区间的风险比（HRs）来衡量合并效应，具体取决于纳入研究之间的异质性。使用χ²和I²检验对这些试验之间的异质性进行统计学评估。还进行了敏感性分析。
共纳入9项研究，包含4958例患者。肝切除术与TACE的比较显示，3年OS的合并HR为0.403（95%CI 0.364 - 0.446，p = 0.000；I² = 0%，p = 0.643），5年OS的合并HR为0.433（95%CI 0.394 - 0.475，p = 0.000；I² = 0%，p = 0.468）。甲胎蛋白（AFP）水平>400 ng/ml和乙肝病毒（HBV）阳性是与总生存显著相关的因素。对于治疗相关并发症，肝切除术与TACE相比的总体比值比（OR）为0.990（95%CI 0.934 - 1.049；p = 0.728；I² = 64.5%，p = 0.060）。
与单纯TACE相比，肝切除术可能改善BCLC分期为B期HCC患者的总生存，但未增加治疗相关并发症的发生率。AFP水平>400 ng/ml和HBV阳性与较差的总生存显著相关。
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