Labgaa Ismail, Taffé Patrick, Martin David, Clerc Daniel, Schwartz Myron, Kokudo Norihiro, Denys Alban, Halkic Nermin, Demartines Nicolas, Melloul Emmanuel
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Institute of Social and Preventive Medicine, Cochrane Switzerland, Lausanne University Hospital CHUV, Lausanne, Switzerland.
Liver Cancer. 2020 Apr;9(2):138-147. doi: 10.1159/000505093. Epub 2020 Jan 28.
According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, transarterial chemoembolization (TACE) is recommended in patients with hepatocellular carcinoma (HCC) of intermediate stage (BCLC-B), whereas partial hepatectomy (PH) is restricted to early stage A. Expanding the indication for PH to intermediate stage remains debated.
This meta-analysis aimed to analyze short- and long-term outcomes of PH compared to TACE in patients with intermediate-stage HCC.
A meta-analysis was conducted according to PRISMA guidelines. Trials comparing PH with TACE in patients with intermediate-stage HCC were selected. Only patients of BCLC-B stage were included in the analyses. Primary endpoint was overall survival (OS) and secondary endpoint was 90-day postprocedural mortality. Random-effects models were used to analyze time ratios (TRs).
Seven eligible trials were analyzed, including 1,730 BCLC-B patients undergoing PH ( = 750) or TACE ( = 980). Comparison of OS between PH and TACE determined a pooled TR of 1.91 (95% CI 1.24-2.94; < 0.001). Survival rates at 1-, 3-, and 5-year were 85, 60, and 42% after PH, compared to 73, 60, and 20% after TACE ( < 0.001). There was no difference in postprocedural mortality between PH and TACE with rates of 3.7 and 3.4%, respectively (TR 0.95; 95% CI 0.17-5.50; = 0.879).
In patients with intermediate HCC, PH was associated with increased long-term survival compared to TACE, with comparable postprocedural mortality. These results suggest considering PH as treatment option in intermediate HCC and highlight the urgent need to refine the selection of patients with BCLC-B stage who may benefit from PH.
根据巴塞罗那临床肝癌（BCLC）分期系统，对于中期肝细胞癌（HCC，BCLC-B期）患者，推荐行经动脉化疗栓塞术（TACE），而肝部分切除术（PH）则仅限于早期（A期）患者。将PH的适应证扩展至中期仍存在争议。
本荟萃分析旨在分析中期HCC患者接受PH与TACE治疗的短期和长期结局。
根据PRISMA指南进行荟萃分析。选取比较中期HCC患者接受PH与TACE治疗的试验。分析仅纳入BCLC-B期患者。主要终点为总生存期（OS），次要终点为术后90天死亡率。采用随机效应模型分析时间比（TR）。
分析了7项符合条件的试验，包括1730例接受PH（n = 750）或TACE（n = 980）的BCLC-B期患者。PH与TACE的OS比较得出合并TR为1.91（95% CI 1.24 - 2.94；P < 0.001）。PH术后1年、3年和5年生存率分别为85%、60%和42%，而TACE术后分别为73%、60%和20%（P < 0.001）。PH与TACE术后死亡率无差异，分别为3.7%和3.4%（TR 0.95；95% CI 0.17 - 5.50；P = 0.879）。
在中期HCC患者中，与TACE相比，PH可提高长期生存率，且术后死亡率相当。这些结果提示可将PH作为中期HCC的治疗选择，并凸显了迫切需要优化BCLC-B期可能从PH中获益患者选择的必要性。
