肝移植与米兰标准以外的 HBV 相关肝细胞癌患者的肝切除术：一项荟萃分析。

Liver transplantation vs liver resection in patients with HBV-related hepatocellular carcinoma beyond Milan criterion: A meta-analysis.

机构信息

Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China.

Department of General Surgery, Dingxi People's Hospital, Lanzhou University Second Hospital Dingxi Hospital, Dingxi, China.

出版信息

Clin Transplant. 2018 Mar;32(3):e13193. doi: 10.1111/ctr.13193. Epub 2018 Jan 30.

DOI:10.1111/ctr.13193

PMID:29315813

Abstract

OBJECTIVE

The aim of this study was to conduct a meta-analysis of published reports to compare long-term outcomes after liver transplantation (LT) and liver resection (LR), respectively, in patients with HBV-related hepatocellular carcinoma (HCC) beyond the Milan criterion.

METHODS

A systematic search of the Embase, Medline, PubMed databases, and the Cochrane Library was performed using both medical subject headings (MeSH) and truncated word searches to identify all comparative studies published on this topic. The primary outcomes were postoperative overall survival (OS) and disease-free survival (DFS). We calculated the pooled hazard ratios (HR) with 95% confidence intervals (95% CI) of OS and DFS.

RESULTS

Pooled analysis of six studies, with a total of 1697 patients with HCC beyond Milan criteria, did not reveal a statistically significant improvement in OS in patients undergoing LT vs LR (LT vs LR, HR: 0.83, 95% CI: 0.68-1.01, P = .06), without significant heterogeneity (χ = 8.38, I = 40.3%, P = .137). Five studies with a total of 1511 patients were included in pooled analysis of DFS between LT and LR group. In the fixed-effects model, patients in the LT group gained significantly better DFS (LT vs LR, HR: 0.45, 95% CI: 0.37-0.56, P < .001) than patients in the LR group, with no significant heterogeneity (χ = 6.80, I = 41.6%, P = .144). Four studies provided the data of adjusted HRs (LT vs LR). In the fixed-effects model, patients in the LT group had significantly better OS (HR: 0.58, 95% CI: 0.44-0.77, P < .001, I = 0%) and DFS (HR: 0.14, 95% CI: 0.08-0.23, P < .001, I = 0%) than those of patients in the LR group. The sensitivity analyses revealed that the results were robust.

CONCLUSION

Our meta-analysis demonstrated that HBV-related patients with HCC beyond Milan criterion who underwent LT gained better OS and DFS compared with patients who underwent LR after adjusting confounding factors.

摘要

目的

本研究旨在通过对发表的报告进行荟萃分析，比较米兰标准以外的乙型肝炎病毒相关肝细胞癌（HCC）患者行肝移植（LT）和肝切除术（LR）的长期预后。

方法

使用医学主题词（MeSH）和截断词搜索对 Embase、Medline、PubMed 数据库和 Cochrane 图书馆进行系统检索，以确定所有关于该主题的比较研究。主要结局为术后总生存期（OS）和无病生存期（DFS）。我们计算了 OS 和 DFS 的合并危险比（HR）及其 95%置信区间（95%CI）。

结果

对 6 项研究的汇总分析共纳入了 1697 例米兰标准以外的 HCC 患者，结果显示 LT 组患者的 OS 并未显著优于 LR 组（LT 组 vs LR 组，HR：0.83，95%CI：0.68-1.01，P=0.06），无显著异质性（χ²=8.38，I=40.3%，P=0.137）。纳入 LT 组和 LR 组 DFS 汇总分析的 5 项研究共纳入了 1511 例患者。在固定效应模型中，LT 组患者的 DFS 显著优于 LR 组（LT 组 vs LR 组，HR：0.45，95%CI：0.37-0.56，P<0.001），异质性无统计学意义（χ²=6.80，I=41.6%，P=0.144）。4 项研究提供了校正 HR 的数据。在固定效应模型中，LT 组患者的 OS（HR：0.58，95%CI：0.44-0.77，P<0.001，I=0%）和 DFS（HR：0.14，95%CI：0.08-0.23，P<0.001，I=0%）均显著优于 LR 组患者。敏感性分析表明结果稳健。