Yuan Bao-Hong, Li Ru-Hong, Yuan Wei-Ping, Yang Tian, Tong Tie-Jun, Peng Ning-Fu, Li Le-Qun, Zhong Jian-Hong
Department of General Surgery, Yan'An Hospital Affiliated to Kunming Medical University, Kunming, P.R. China.
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China.
Oncotarget. 2017 Mar 14;8(11):18537-18549. doi: 10.18632/oncotarget.14507.
The harms and benefits of adoptive immunotherapy (AIT) for patients with postoperative hepatocellular carcinoma (HCC) are controversial among studies. This study aims to update the current evidence on efficacy and safety of AIT for patients with HCC who have received curative therapy. Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and cohort studies evaluating adjuvant AIT for patients with HCC after curative therapies. Recurrence and mortality were compared between patients with or without adjuvant AIT. Eight RCTs and two cohort studies involving 2,120 patients met the eligibility criteria and were meta-analyzed. Adjuvant AIT was associated with significantly lower recurrence rate than curative therapies alone at 1 year [risk ratio (RR) 0.64, 95%CI 0.49-0.82], 3 years (RR 0.85, 95%CI 0.79-0.91) and 5 years (RR 0.90, 95%CI 0.85-0.95). Similarly, adjuvant AIT was associated with significantly lower mortality at 1 year (RR 0.64, 95%CI 0.52-0.79), 3 years (RR 0.73, 95%CI 0.65-0.81) and 5 years (RR 0.86, 95%CI 0.79-0.94). Short-term outcomes were confirmed in sensitivity analyses based on RCTs or choice of a fixed- or random-effect meta-analysis model. None of the included patients experienced grade 3 or 4 adverse events. Therefore, this update reinforces the evidence that adjuvant AIT after curative treatment for HCC lowers risk of recurrence and mortality.
过继性免疫疗法（AIT）对术后肝细胞癌（HCC）患者的利弊在各项研究中存在争议。本研究旨在更新关于AIT对接受根治性治疗的HCC患者的疗效和安全性的现有证据。我们系统检索了电子数据库，以识别评估根治性治疗后HCC患者辅助性AIT的随机对照试验（RCT）和队列研究。比较了接受或未接受辅助性AIT患者的复发率和死亡率。八项RCT和两项队列研究共纳入2120例患者，符合纳入标准并进行了荟萃分析。辅助性AIT与单独根治性治疗相比，在1年时复发率显著降低[风险比（RR）0.64，95%置信区间（CI）0.49 - 0.82]，3年时（RR 0.85，95%CI 0.79 - 0.91）以及5年时（RR 0.90，95%CI 0.85 - 0.95）。同样，辅助性AIT在1年时（RR 0.64，95%CI 0.52 - 0.79）、3年时（RR 0.73，95%CI 0.65 - 0.81）和5年时（RR 0.86，95%CI 0.79 - 0.94）死亡率也显著降低。基于RCT或固定效应或随机效应荟萃分析模型选择的敏感性分析证实了短期结果。纳入的患者均未发生3级或4级不良事件。因此，本次更新强化了以下证据：HCC根治性治疗后辅助性AIT可降低复发和死亡风险。
