Chen Wen, Ma Tao, Zhang Jian, Zhang Xiaozhen, Chen Wei, Shen Yinan, Bai Xueli, Liang Tingbo
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, China; Innovation Center for the Study of Pancreatic Diseases, Zhejiang Province, China.
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou 310009, China; Innovation Center for the Study of Pancreatic Diseases, Zhejiang Province, China.
HPB (Oxford). 2020 Jun;22(6):795-808. doi: 10.1016/j.hpb.2019.12.013. Epub 2020 Jan 21.
The aim of this study was to systematically evaluate and determine those patients with hepatocellular carcinoma (HCC) that would benefit from the administration of postoperative adjuvant transarterial chemoembolization (PA-TACE).
PubMed, Embase and Cochrane Library were searched for randomized controlled trials (RCTs) and observational studies up to July 30, 2019. The outcome of Overall survival (OS) and disease-free survival (DFS) were extracted and converted to hazard ratios (HRs) with 95% confidence intervals (95%CIs).
A total of 40 studies (10 RCTs and 30 non-RCTs) involving 11,165 patients were included. Overall, PA-TACE was associated with an increased OS [HR, 0.71 (95% CI, 0.65-0.77); P < 0.001] and DFS [HR, 0.73 (95% CI, 0.66-0.80); P < 0.001]. Subgroup analysis in patients with microvascular invasion (MVI), tumor diameter >5 cm or multinodular tumors demonstrated that PA-TACE improved OS and DFS. In patients without MVI, PA-TACE showed no improvement in OS [HR, 1.14 (95% CI, 0.85-1.53); P = 0.370], and resulted in worse DFS than curative resection alone [HR, 1.20 (95% CI, 1.03-1.39); P = 0.002].
This meta-analysis indicated that PA-TACE was beneficial in patients with HCC who were at high risk of postoperative recurrence including tumor diameter >5 cm, multinodular tumors and MVI-positive. In patients with tumor diameter ≤5 cm, single tumor or MVI-negative. PA-TACE does not appear to improve outcomes and may potentially promote postoperative recurrence in certain patients.
本研究旨在系统评估并确定那些能从术后辅助性经动脉化疗栓塞术（PA-TACE）中获益的肝细胞癌（HCC）患者。
检索PubMed、Embase和Cochrane图书馆中截至2019年7月30日的随机对照试验（RCT）和观察性研究。提取总生存期（OS）和无病生存期（DFS）的结果，并转换为具有95%置信区间（95%CI）的风险比（HR）。
共纳入40项研究（10项RCT和30项非RCT），涉及11,165例患者。总体而言，PA-TACE与OS增加相关[HR，0.71（95%CI，0.65-0.77）；P<0.001]和DFS增加相关[HR，0.73（95%CI，0.66-0.80）；P<0.001]。对微血管侵犯（MVI）、肿瘤直径>5 cm或多结节肿瘤患者的亚组分析表明，PA-TACE改善了OS和DFS。在无MVI的患者中，PA-TACE在OS方面无改善[HR，1.14（95%CI，0.85-1.53）；P=0.370]，且与单纯根治性切除相比，DFS更差[HR，1.20（95%CI，1.03-1.39）；P=0.002]。
这项荟萃分析表明，PA-TACE对术后复发高危的HCC患者有益，包括肿瘤直径>5 cm、多结节肿瘤和MVI阳性患者。对于肿瘤直径≤5 cm、单肿瘤或MVI阴性的患者，PA-TACE似乎并未改善预后，且可能在某些患者中促进术后复发。
