Menahem Benjamin, Lubrano Jean, Duvoux Christophe, Mulliri Andrea, Alves Arnaud, Costentin Charlotte, Mallat Ariane, Launoy Guy, Laurent Alexis
Department of Digestive Surgery, University Hospital of Caen, Caen, France.
Normandie Université, UNICAEN, CEA, Centre National de la Recherche Scientifique, Centre Hospitalier Universitaire Caen, INSERM Unités Mixtes de Recherche 1086, Centre François Baclesse, Caen, France.
Liver Transpl. 2017 Jun;23(6):836-844. doi: 10.1002/lt.24758.
This meta-analysis compared the effects of liver transplantation (LT) and liver resection (LR) on overall survival (OS) and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) small transplantable HCC or within Milan criteria. Articles comparing LR with LT for HCC, based on Milan criteria or small size, published up to June 2015 were selected, and a meta-analysis was performed. No randomized controlled trial has been published to date comparing survival outcomes in patients with HCC who underwent LR and LT. Nine studies were identified, including 570 patients who underwent LR and 861 who underwent LT. For HCC within the Milan criteria, the 1-year OS rates following LR and LT were 84.5% (473/560) and 84.4% (710/841), respectively (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.71-1.33; P = 0.8), and the 5-year OS rates were 47.9% (273/570) and 59.3% (509/858), respectively (OR, 0.60; 95% CI, 0.35-1.02; P = 0.06). One-year DFS rates were similar (OR, 1.00; 95% CI, 0.39-2.61; P = 1.00), whereas the 3-year DFS rate was significantly lower in the LR group (54.4%, 210/386) than in the LT group (74.2%, 317/427; OR, 0.24; 95% CI, 0.07-0.80; P = 0.02), and the 5-year DFS rate was significantly lower for LR than LT (OR, 0.18; 95% CI, 0.06-0.53; P < 0.01). For small HCCs, the 5-year OS rate was significantly lower for patients who underwent LR than LT (OR, 0.30; 95% CI, 0.19-0.48; P < 0.001). In conclusion, relative to LR, LT in patients with HCC meeting the Milan criteria had no benefits before 10 years for OS. For DFS, the benefit is obtained after 3 years. Liver Transplantation 23 836-844 2017 AASLD.
本荟萃分析比较了肝移植（LT）和肝切除术（LR）对符合米兰标准或可移植的小肝细胞癌（HCC）患者总生存期（OS）和无病生存期（DFS）的影响。选取了截至2015年6月发表的、基于米兰标准或肿瘤大小比较LR与LT治疗HCC的文章，并进行荟萃分析。迄今为止，尚无比较接受LR和LT的HCC患者生存结局的随机对照试验发表。共纳入9项研究，包括570例行LR的患者和861例行LT的患者。对于符合米兰标准的HCC，LR和LT术后1年OS率分别为84.5%（473/560）和84.4%（710/841）（优势比[OR]，0.98；95%置信区间[CI]，0.71 - 1.33；P = 0.8），5年OS率分别为47.9%（273/570）和59.3%（509/858）（OR，0.60；95% CI，0.35 - 1.02；P = 0.06）。1年DFS率相似（OR，1.00；95% CI，0.39 - 2.61；P = 1.00），而LR组3年DFS率（54.4%，210/386）显著低于LT组（74.2%，317/427；OR，0.24；95% CI，0.07 - 0.80；P = 0.02），LR组5年DFS率也显著低于LT组（OR，0.18；95% CI，0.06 - 0.53；P < 0.01）。对于小HCC，接受LR的患者5年OS率显著低于接受LT的患者（OR，0.30；95% CI，0.19 - 0.48；P < 0.001）。总之，相对于LR，符合米兰标准的HCC患者接受LT在10年内对OS无益处。对于DFS，3年后有获益。《肝脏移植》2017年第23卷836 - 844页，美国肝病研究学会。
