Department of Surgery and Cancer, Imperial College London, London, UK.
Br J Surg. 2017 Oct;104(11):1433-1442. doi: 10.1002/bjs.10597. Epub 2017 Jun 19.
Intrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence.
A systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival.
Nineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056).
Based on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.
肝癌切除术后肝内复发较为常见，但目前尚无共识指南来指导此类患者的治疗决策。对不同治疗方法的生存情况进行系统评价和荟萃分析，可能有助于治疗方案的选择。本研究旨在确定肝癌复发的最佳治疗策略。
根据 MOOSE 指南进行了系统评价，检索截至 2016 年 9 月。主要结局指标为不同治疗方法的总生存率的危险比。采用随机效应模型对不同治疗方法进行荟萃分析，并进一步评估生存的其他预后因素。
最终纳入了 19 项队列研究（2764 例患者）进行数据分析。再次肝切除（525 例）、消融（658 例）和经动脉化疗栓塞（TACE）（855 例）后的中位 5 年生存率分别为 35.2%、48.3%和 15.5%。10 项研究的荟萃分析表明，消融与再次肝切除的总生存率无显著差异（危险比 1.03，95%可信区间 0.68 至 1.55；P=0.897）。7 项比较 TACE 与再次肝切除的研究的荟萃分析显示，生存方面无统计学差异（危险比 1.61，0.99 至 2.63；P=0.056）。
根据这些有限的数据，对于复发性 HCC 患者，再次肝切除或消融治疗的生存率似乎没有显著差异。这些结果还确定了重要的负性预后因素（无疾病间期短、多个肝转移灶和大的肝转移灶），这些因素可能影响治疗选择。
