Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Hepatobiliary and Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China.
Gastrointestinal Tumor Center, Chongqing University Cancer Hospital, Chongqing, China.
Clin Res Hepatol Gastroenterol. 2020 Apr;44(2):142-154. doi: 10.1016/j.clinre.2019.06.012. Epub 2019 Jul 11.
Microvascular invasion (MVI) has been associated with a poor prognosis for hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the efficacy and safety of adjuvant transarterial chemoembolization (TACE) after curative hepatectomy for HCC with MVI.
An online search on Embase and Ovid MEDLINE(R) was conducted to identify the appropriate articles published prior to March 11, 2019. The primary endpoint was the overall survival (OS) of patients treated using adjuvant TACE after hepatectomy (HTAT) versus hepatectomy (HT) alone for HCC with MVI. The secondary endpoints were disease-free survival (DFS) and safety.
Seven studies with 1869 patients were included in this analysis. Meta-analyses demonstrated that HTAT was superior to HT in OS (Hazard Ratio [HR]: 0.67, 95%CI: 0.58-0.77, P<0.001) and DFS (HR: 0.71, 95%CI: 0.62-0.81, P<0.001) for treating HCC with MVI. Subgroup analysis revealed that for early-stage HCC, HTAT was associated with longer OS (P=0.009) and DFS (P=0.066) as compared with HT. For HCC larger than 5cm, HTAT also prolonged the DFS (P=0.008) of patients, but the difference in OS was not statistically significant (P=0.266). Adjuvant TACE commonly caused nausea and vomiting, liver dysfunction, leucopenia, pain, and fever.
Adjuvant TACE after hepatectomy is effective and safe for patients with HCC accompanied by MVI. However, the benefit of adjuvant TACE in patients who have HCC with a diameter >5cm is not clear. Further randomized controlled studies are warranted to test these conclusions.
微血管侵犯（MVI）与肝细胞癌（HCC）患者的预后不良相关。本研究旨在评估 MVI 阳性 HCC 患者根治性肝切除术后辅助经动脉化疗栓塞（TACE）的疗效和安全性。
在 Embase 和 Ovid MEDLINE（R）上进行在线检索，以确定截至 2019 年 3 月 11 日前发表的适当文章。主要终点是 MVI 阳性 HCC 患者接受辅助 TACE 治疗（HTAT）与单独接受肝切除术（HT）的总生存（OS）。次要终点是无病生存（DFS）和安全性。
本分析纳入了 7 项研究共 1869 例患者。荟萃分析表明，HTAT 在 OS（风险比 [HR]：0.67，95%CI：0.58-0.77，P<0.001）和 DFS（HR：0.71，95%CI：0.62-0.81，P<0.001）方面优于 HT，用于治疗 MVI 阳性 HCC。亚组分析显示，对于早期 HCC，HTAT 与更长的 OS（P=0.009）和 DFS（P=0.066）相关。对于直径大于 5cm 的 HCC，HTAT 也延长了患者的 DFS（P=0.008），但 OS 差异无统计学意义（P=0.266）。辅助 TACE 常引起恶心、呕吐、肝功能异常、白细胞减少、疼痛和发热。
肝切除术后辅助 TACE 对 MVI 阳性 HCC 患者有效且安全。然而，对于直径>5cm 的 HCC 患者，辅助 TACE 的益处尚不清楚。需要进一步的随机对照研究来验证这些结论。
