单纯肝切除术与联合术前及术后经动脉化疗栓塞术治疗肝细胞癌：一项系统评价和荟萃分析。
Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis.
作者信息
Qi Xingshun, Liu Lei, Wang Diya, Li Hongyu, Su Chunping, Guo Xiaozhong
机构信息
Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China.
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
出版信息
Oncotarget. 2015 Nov 3;6(34):36838-59. doi: 10.18632/oncotarget.5426.
BACKGROUND AND AIMS
The prognosis of hepatocellular carcinoma (HCC) treated with hepatic resection may be improved by the adjunctive use of transarterial chemoembolization (TACE). This study aimed to systematically compare the outcomes between hepatic resection with and without TACE groups.
METHODS
All relevant randomized controlled trials (RCTs) and non-RCTs were searched by the PubMed, EMBASE, and Cochrane Library databases. Overall survival (OS) and disease-free survival (DFS) were two major outcomes. Meta-analyses were performed according to the timing of TACE (pre- or post-operative TACE). Subgroup analyses were also performed. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were calculated.
RESULTS
Overall, 55 papers were included (14 RCTs and 41 non-RCTs). Overall meta-analyses demonstrated that OS and DFS were statistically similar between hepatic resection with and without pre-operative TACE groups (HR = 1.01, 95%CI = 0.87-1.19, P = 0.87; HR = 0.91, 95%CI = 0.82-1.01, P = 0.07). Subgroup analyses of RCTs or non-RCTs showed that OS and DFS remained statistically similar between hepatic resection with and without pre-operative TACE groups. Subgroup analysis of incomplete or no tumor necrosis showed that OS was worse in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. By contrast, subgroup analysis of complete tumor necrosis showed that DFS was better in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group.Overall meta-analyses demonstrated that OS and DFS were better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group (HR = 0.85, 95%CI = 0.72-1.00, P = 0.06; HR = 0.83, 95%CI = 0.73-0.94, P = 0.004). Subgroup analyses of RCTs, vascular invasion, or large HCC showed that OS and DFS remained better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group. By contrast, subgroup analyses of non-RCTs, no vascular invasion, or small HCC showed that OS and DFS were statistically similar between the two groups.
CONCLUSIONS
Post-operative TACE, rather than pre-operative TACE, may be considered as an adjunctive treatment option for HCC treated with hepatic resection.
背景与目的
经动脉化疗栓塞术（TACE）辅助治疗可改善接受肝切除术的肝细胞癌（HCC）患者的预后。本研究旨在系统比较肝切除联合TACE组与未联合TACE组的治疗效果。
方法
通过PubMed、EMBASE和Cochrane图书馆数据库检索所有相关的随机对照试验（RCT）和非RCT。总生存期（OS）和无病生存期（DFS）是两个主要观察指标。根据TACE的时机（术前或术后TACE）进行荟萃分析。还进行了亚组分析。计算风险比（HR）及95%置信区间（95%CI）。
结果
共纳入55篇文献（14项RCT和41项非RCT）。总体荟萃分析表明，肝切除联合术前TACE组与未联合术前TACE组的OS和DFS在统计学上相似（HR = 1.01，95%CI = 0.87 - 1.19，P = 0.87；HR = 0.91，95%CI = 0.82 - 1.01，P = 0.07）。RCT或非RCT的亚组分析显示，肝切除联合术前TACE组与未联合术前TACE组的OS和DFS在统计学上仍相似。不完全或无肿瘤坏死的亚组分析显示，肝切除联合术前TACE组的OS比未联合术前TACE组差。相比之下，完全肿瘤坏死的亚组分析显示，肝切除联合术前TACE组的DFS比未联合术前TACE组好。总体荟萃分析表明，肝切除联合术后TACE组的OS和DFS优于未联合术后TACE组（HR = 0.85，95%CI = 0.72 - 1.00，P = 0.06；HR = 0.83，95%CI = 0.73 - 0.94，P = 0.004）。RCT、血管侵犯或大肝癌的亚组分析显示，肝切除联合术后TACE组的OS和DFS仍优于未联合术后TACE组。相比之下，非RCT、无血管侵犯或小肝癌的亚组分析显示，两组的OS和DFS在统计学上相似。
结论
对于接受肝切除术的HCC患者，术后TACE而非术前TACE可作为一种辅助治疗选择。
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