Wang Chong, Yang Lei, Liang Zikun, Liu Yaodong, Liu Shuku
Thoracic Minimally Invasive Treatment Center, Beijing Chest Hospital, Capital Medical University, No. 9, Beiguan Avenue, Beijing, 101149, China.
Department of Thoracic Surgery, Baoshan Hospital, Chifeng City, Inner Mongolia Autonomous Region, China.
World J Surg. 2018 Jul;42(7):2153-2163. doi: 10.1007/s00268-017-4431-7.
Lung is the most common extrahepatic metastatic organ of liver cancer. Surgical resection is a common local treatment for pulmonary metastasis. But the long-term prognosis of pulmonary metastasectomy varies greatly due to the small sample size and different results of previous studies. Therefore, we conducted this meta-analysis to evaluate the combined 5-year overall survival (OS) rate and prognostic factors after pulmonary metastasectomy in liver cancer.
Key words such as liver cancer pulmonary metastasis and metastasectomy were retrieved firstly in PubMed, Cochrane Library, Embase and Chinese Wanfang databases. Eligible studies were identified by manual searches. Each included study should report 5-year OS rate and/or prognostic factors of pulmonary metastasectomy. Newcastle-Ottawa Scale was used for quality assessment, and heterogeneity was estimated by I. We calculated the combined 5-year survival rates and determined the prognostic factors for OS by the hazard ratios (HR) and number of events.
Seventeen cohort studies with a total of 513 patients were included in this meta-analysis. The combined 5-year survival rates after pulmonary metastasectomy were 33% [95% confidence interval (95% CI) 29-37%]. The poor prognostic factors were disease-free interval (DFI) < 12 months (HR = 2.421 95% CI 1.384 4.236) and existence of cirrhosis (HR = 1.936 95% CI 1.031 3.636).
The 5-year OS rate of patients with pulmonary metastasectomy after resection of primary liver cancer is 33%. DFI < 12 months and existence of cirrhosis are probably poor prognostic factors.
肺是肝癌最常见的肝外转移器官。手术切除是治疗肺转移的常见局部治疗方法。但由于样本量小以及既往研究结果不同，肺转移瘤切除术的长期预后差异很大。因此，我们进行了这项荟萃分析，以评估肝癌肺转移瘤切除术后的5年总生存率（OS）及预后因素。
首先在PubMed、Cochrane图书馆、Embase和中国万方数据库中检索肝癌肺转移和转移瘤切除术等关键词。通过人工检索确定符合条件的研究。每项纳入研究均应报告肺转移瘤切除术的5年OS率和/或预后因素。采用纽卡斯尔-渥太华量表进行质量评估，并用I²估计异质性。我们计算了合并的5年生存率，并通过风险比（HR）和事件数确定OS的预后因素。
本荟萃分析纳入了17项队列研究，共513例患者。肺转移瘤切除术后的合并5年生存率为33%[95%置信区间（95%CI）29 - 37%]。预后不良因素为无病生存期（DFI）<12个月（HR = 2.421，95%CI 1.384 - 4.236）和存在肝硬化（HR = 1.936，95%CI 1.031 - 3.636）。
原发性肝癌切除术后肺转移瘤切除患者的5年OS率为33%。DFI<12个月和存在肝硬化可能是预后不良因素。
