肝切除术与经动脉化疗栓塞治疗合并门静脉癌栓的肝细胞癌的生存获益：系统评价和荟萃分析。
Survival benefit of hepatic resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis.
机构信息
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
Department of Laboratory Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
出版信息
BMC Cancer. 2017 Dec 28;17(1):902. doi: 10.1186/s12885-017-3895-z.
BACKGROUND
No consensus treatment has been reached for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Hepatic resection (HR) and transarterial chemoembolization (TACE) have been recommended as effective options, but which is better remains unclear. This meta-analysis is to compare the effectiveness of HR and TACE for HCC with PVTT patients.
METHODS
The PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched for comparing HR and TACE treating PVTT.
RESULTS
Twelve retrospective studies with 3129 patients were included. A meta-analysis of 11 studies suggested that the 1-, 2-, 3-, and 5-year overall survival (OS) rates (OR = 0.48, 95% CI = 0.41-0.57, I = 37%, P < 0.00001; OR = 0.21, 95% CI = 0.12-0.38, I = 43%, P < 0.00001; OR = 0.35, 95% CI = 0.28-0.44, I = 53%, P < 0.00001; OR = 0.28, 95% CI = 0.14-0.54, I = 72%, P = 0.0001, respectively) favored HR over TACE. In a subgroup analysis, HR had better 1-, 2-,3, 5-year OS for type I PVTT (OR = 0.33, 95% CI = 0.17-0.64, I = 20%, P = 0.001; OR = 0.32, 95% CI = 0.16-0.63, I2 = 0%, P = 0.001; OR = 0.18, 95% CI = 0.09-0.36, I2 = 0%, P < 0.00001; OR = 0.07, 95% CI = 0.01-0.32, I2 = 0%, P = 0.0006, respectively) and better 1-, 3-, and 5-year OS for type II PVTT (OR = 0.37, 95% CI = 0.20-0.70, I = 59%, P = 0.002; OR = 0.22, 95% CI = 0.13-0.39, I = 0%, P < 0.00001; OR = 0.16; 95% CI = 0.03-0.91; I = 51%, P = 0.04, respectively). There was no difference in 1-, 3-, or 5-year OS between HR and TACE for type III PVTT (OR = 0.86, 95% CI = 0.61-1.21, I = 0%, P = 0.39; OR = 0.83, 95% CI = 0.42-1.64, I = 0%, P = 0.59; OR = 0.59, 95% CI = 0.06--6.04, I = 65%, P = 0.66, respectively).
CONCLUSIONS
HR may lead to longer OS for some selected HCC patients with PVTT than TACE, especially for type I or II PVTT, with less difference being observed for type III or IV PVTT.
背景
对于合并门静脉癌栓（PVTT）的肝细胞癌（HCC），尚未达成共识的治疗方法。肝切除术（HR）和经动脉化疗栓塞术（TACE）已被推荐为有效的选择，但哪种方法更好尚不清楚。本荟萃分析旨在比较 HR 和 TACE 治疗 HCC 合并 PVTT 患者的疗效。
方法
系统检索了 PubMed、EMBASE、Cochrane 图书馆、VIP、万方和中国生物医学文献数据库，以比较 HR 和 TACE 治疗 PVTT 的研究。
结果
纳入了 12 项回顾性研究，共 3129 名患者。11 项研究的荟萃分析表明，1、2、3 和 5 年总生存率（OS）率（OR=0.48，95%CI=0.41-0.57，I=37%，P<0.00001；OR=0.21，95%CI=0.12-0.38，I=43%，P<0.00001；OR=0.35，95%CI=0.28-0.44，I=53%，P<0.00001；OR=0.28，95%CI=0.14-0.54，I=72%，P=0.0001）均有利于 HR 优于 TACE。在亚组分析中，HR 对于 I 型 PVTT 具有更好的 1、2、3、5 年 OS（OR=0.33，95%CI=0.17-0.64，I=20%，P=0.001；OR=0.32，95%CI=0.16-0.63，I2=0%，P=0.001；OR=0.18，95%CI=0.09-0.36，I2=0%，P<0.00001；OR=0.07，95%CI=0.01-0.32，I2=0%，P=0.0006），对于 II 型 PVTT 也具有更好的 1、3 和 5 年 OS（OR=0.37，95%CI=0.20-0.70，I=59%，P=0.002；OR=0.22，95%CI=0.13-0.39，I=0%，P<0.00001；OR=0.16，95%CI=0.03-0.91，I=51%，P=0.04）。对于 III 型 PVTT，HR 和 TACE 之间在 1、3 或 5 年 OS 方面无差异（OR=0.86，95%CI=0.61-1.21，I=0%，P=0.39；OR=0.83，95%CI=0.42-1.64，I=0%，P=0.59；OR=0.59，95%CI=0.06-6.04，I=65%，P=0.66）。
结论
对于某些选择的 HCC 合并 PVTT 患者，HR 可能比 TACE 导致更长的 OS，尤其是对于 I 型或 II 型 PVTT，而对于 III 型或 IV 型 PVTT 则观察到较小的差异。
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