Liao Mingheng, Zhu Zexin, Wang Haichuan, Huang Jiwei
a Department of Liver Surgery , Liver Transplantation Division, West China Hospital, Sichuan University , Chengdu , China.
Scand J Gastroenterol. 2017 Jun-Jul;52(6-7):624-634. doi: 10.1080/00365521.2017.1292365. Epub 2017 Feb 22.
To evaluate the efficacy and safety of adjuvant transarterial chemoembolization (TACE) after curative hepatectomy in improving the survival of patients with primary hepatocellular carcinoma (HCC).
MEDLINE, Embase and the Cochrane Library were searched for randomized or nonrandomized studies comparing postoperative adjuvant TACE with curative resection alone. Meta-analysis was performed after converting time-event data into a hazard ratio (HR), using an inverse diversity model.
Eight randomized controlled trials (RCTs) and 12 retrospective studies matched the selection criteria, thereby including 3191 patients (779 in RCT, 2412 in observational studies) for the meta-analysis. The meta-analysis showed that receiving adjuvant TACE was associated with improved overall survival (OS, ln[HR] = 0.70, 95%CI: 0.63-0.78, p < .001) and recurrence-free survival (RFS, ln[HR] = 0.69, 95%CI: 0.63-0.76, p < .001) after curative hepatectomies. The results of observational studies were consistent with those of RCTs. Furthermore, meta-regression was utilized to detect study-level factors associated with treatment outcome. It revealed that overall survival was similar among patients treated with various combinations of chemotherapeutic drugs. Subgroup analyses demonstrated that repeated TACE interventions do not provide a higher survival benefit compared with a single course, and patients with a single tumor or tumor size ≥5cm might stand to benefit the most from adjuvant TACE therapy.
This meta-analysis demonstrated that postoperative adjuvant TACE could achieve higher OS and RFS than surgical resection alone. However, these results need to be validated through further high-quality clinical studies.
评估根治性肝切除术后辅助性经动脉化疗栓塞术（TACE）在提高原发性肝细胞癌（HCC）患者生存率方面的疗效和安全性。
检索MEDLINE、Embase和Cochrane图书馆，查找比较术后辅助性TACE与单纯根治性切除术的随机或非随机研究。在将时间-事件数据转换为风险比（HR）后，使用逆方差模型进行荟萃分析。
8项随机对照试验（RCT）和12项回顾性研究符合入选标准，从而纳入3191例患者（RCT中779例，观察性研究中2412例）进行荟萃分析。荟萃分析表明，接受辅助性TACE与根治性肝切除术后总生存期（OS，ln[HR]=0.70，95%CI：0.63-0.78，p<.001）和无复发生存期（RFS，ln[HR]=0.69，95%CI：0.63-0.76，p<.001）的改善相关。观察性研究的结果与RCT的结果一致。此外，利用荟萃回归来检测与治疗结果相关的研究水平因素。结果显示，接受不同化疗药物组合治疗的患者总生存期相似。亚组分析表明，与单次疗程相比，重复TACE干预并未提供更高的生存获益，单个肿瘤或肿瘤大小≥5cm的患者可能从辅助性TACE治疗中获益最大。
这项荟萃分析表明术后辅助性TACE比单纯手术切除可实现更高的OS和RFS。然而，这些结果需要通过进一步的高质量临床研究来验证。
