Bankstown-Campbelltown Hospital, South Western Sydney Clinical School, UNSW, Sydney, Australia.
Department of Radiology, Concord Repatriation General Hospital, Sydney, Australia.
Cardiovasc Intervent Radiol. 2020 Apr;43(4):572-586. doi: 10.1007/s00270-019-02392-6. Epub 2020 Jan 2.
Multiple studies have demonstrated adjuvant transcatheter arterial chemoembolization (aTACE) after resection improved outcomes compared to resection alone for patients with hepatocellular carcinoma (HCC). Unlike pre-operative TACE which targets a lesion, aTACE is administered in the proximal hepatic artery to destroy cancer cells within the remaining liver. This systematic review and meta-analysis aims to quantify this survival and disease-free survival (DFS) benefit.
A search of five databases was performed from inception to 20 August 2019.
A total of 26 studies (six randomized controlled trials) involving 7817 patients were included. Patients treated with resection plus aTACE had significantly better 1-year survival (OR, 2.53 [95% CI, 1.70-3.76, p < 0.001) and 1-year DFS (OR, 1.91 [95% CI, 1.60-2.28, p < 0.001) compared to resection alone. The survival benefit remained significant for 2- to 5-year survival (OR 2.39, 1.83, 2.12, 1.87, respectively) and 2- to 4-year DFS (OR 1.85, 1.24, 1.67, respectively). Subgroup analysis showed significant survival benefit with aTACE in microvascular invasion (MVI)-positive HCC, portal venous tumour thrombus (PVTT) that does not involve the main trunk, PVTT-negative, satellite nodules, with and without resection margin < 1 cm. No mortalities were reported with aTACE.
Post-operative aTACE is safe and improves overall and disease-free survival, with the greatest benefit in MVI-positive patients. The current evidence weakly supports the use of adjuvant TACE for patients without PVTT, with PVTT that does not involve the main trunk, with and without a resection margin < 1 cm, and patients with satellite nodules.
Level 1.
多项研究表明，与单独手术切除相比，肝癌（HCC）患者手术后接受经导管动脉化疗栓塞（aTACE）辅助治疗可改善预后。与术前 TACE 靶向病变不同，aTACE 是在肝固有动脉近端给药，以破坏剩余肝脏内的癌细胞。本系统评价和荟萃分析旨在量化这种生存和无病生存（DFS）获益。
从建库到 2019 年 8 月 20 日，对五个数据库进行了检索。
共纳入 26 项研究（6 项随机对照试验），共 7817 例患者。与单独手术切除相比，接受手术切除加 aTACE 治疗的患者 1 年生存率显著提高（OR，2.53 [95%CI，1.70-3.76，p<0.001）和 1 年 DFS（OR，1.91 [95%CI，1.60-2.28，p<0.001）。2 年至 5 年生存率（OR 分别为 2.39、1.83、2.12、1.87）和 2 年至 4 年 DFS（OR 分别为 1.85、1.24、1.67）的生存获益仍有统计学意义。亚组分析显示，在微血管侵犯（MVI）阳性 HCC、不涉及主干的门静脉肿瘤血栓（PVTT）、PVTT 阴性、卫星结节、切缘<1cm 时，aTACE 具有显著的生存获益。未报告 aTACE 相关死亡。
术后 aTACE 安全，可提高总生存率和无病生存率，对 MVI 阳性患者获益最大。目前的证据弱支持对无 PVTT、不涉及主干的 PVTT、切缘<1cm 以及伴有卫星结节的患者使用辅助 TACE。
1 级。
