肝细胞癌合并门静脉血栓形成患者治疗方法的比较：一项系统评价和网状Meta分析

Comparison of treatments for hepatocellular carcinoma patients with portal vein thrombosis: a systematic review and network meta-analysis.

作者信息

Luo Jianchen, Xu Liangliang, Li Lian, Zhang Jingfu, Zhang Ming, Xu Mingqing

机构信息

Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.

Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Ann Transl Med. 2021 Sep;9(18):1450. doi: 10.21037/atm-21-3937.

BACKGROUND

Sorafenib, hepatectomy, and transarterial chemoembolization (TACE) are the recommended treatment for portal vein tumor thrombosis (PVTT) patients. Therefore, the aim of the present study was to conduct a multi-treatment meta-analysis. The aim of the present study was to analyze the survival benefit of different treatments options on PVTT patients.

METHODS

We systematically analyzed 12 randomized controlled trials (4,265 participants) from 2012 to 2019, which compared any of the following treatment options on PVTT patients: TACE, sorafenib, hepatectomy, sorafenib + TACE, hepatectomy + TACE, and sorafenib + hepatectomy. The main outcome was the 1-year survival rate of patients.

RESULTS

The results of the rank probability of effectiveness showed that sorafenib + TACE was more likely to be the most effective treatment, sorafenib + TACE group was ranged rank 1 when compared with the others [hepatectomy group: odds ratio (OR): 0.79, 95% confidence interval (CI): 0.03-18.26; hepatectomy + TACE group: OR: 0.51, 95% CI: 0.01-13.59; sorafenib group: OR: 0.14, 95% CI 0.01-2.29, sorafenib + hepatectomy group: OR: 0.15, 95% CI: 0.00-24.88; and TACE group: OR: 0.51, 95% CI: 0.02-9.88]. The second most effect treatment option was hepatectomy alone.

DISCUSSION

Sorafenib + TACE is more likely to be the most effective treatment option, while hepatectomy alone is the second effective treatment option.

背景

索拉非尼、肝切除术和经动脉化疗栓塞术（TACE）是门静脉肿瘤血栓形成（PVTT）患者的推荐治疗方法。因此，本研究的目的是进行一项多治疗方法的荟萃分析。本研究的目的是分析不同治疗方案对PVTT患者的生存获益。

方法

我们系统分析了2012年至2019年的12项随机对照试验（4265名参与者），这些试验比较了以下任何一种针对PVTT患者的治疗方案：TACE、索拉非尼、肝切除术、索拉非尼+TACE、肝切除术+TACE以及索拉非尼+肝切除术。主要结局是患者的1年生存率。

结果

有效性排序概率结果显示，索拉非尼+TACE更有可能是最有效的治疗方法，与其他组相比，索拉非尼+TACE组排名第一[肝切除组：比值比（OR）：0.79，95%置信区间（CI）：0.03 - 18.26；肝切除术+TACE组：OR：0.51，95%CI：0.01 - 13.59；索拉非尼组：OR：0.14，95%CI 0.01 - 2.29，索拉非尼+肝切除组：OR：0.15，95%CI：0.00 - 24.88；TACE组：OR：0.51，95%CI：0.02 - 9.88]。第二有效的治疗方案是单纯肝切除术。