米兰标准内肝细胞癌的肝切除术与肝移植术对比：18421例患者的荟萃分析
Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients.
作者信息
Koh Jin Hean, Tan Darren Jun Hao, Ong Yuki, Lim Wen Hui, Ng Cheng Han, Tay Phoebe Wen Lin, Yong Jie Ning, Muthiah Mark D, Tan Eunice X, Pang Ning Qi, Kim Beom Kyung, Syn Nicholas, Kow Alfred, Goh Brian K P, Huang Daniel Q
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
出版信息
Hepatobiliary Surg Nutr. 2022 Feb;11(1):78-93. doi: 10.21037/hbsn-21-350.
BACKGROUND
Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria.
METHODS
Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models.
RESULTS
We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01).
CONCLUSIONS
Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT.
背景
肝细胞癌（HCC）肝切除（LR）和肝移植（LT）后的预后存在异质性，可能因地区、时间段和疾病负担的不同而有所差异。我们旨在比较米兰标准内HCC患者LT与LR的总生存期（OS）和无病生存期（DFS）。
方法
两位作者独立检索了Medline和Embase数据库，以查找比较符合米兰标准的HCC患者LT和LR后生存期的研究。使用随机效应模型进行荟萃分析和元回归分析。
结果
我们筛选了2278项研究，纳入了35项研究，共18421例患者。与LT相比，LR的OS较差[风险比（HR）=1.44；95%置信区间（CI）：1.14-1.81；P<0.01]，DFS也较差（HR =2.71；95%CI：2.23-3.28；P<0.01），意向性治疗（ITT）研究中的结果相似。在单结节疾病中，LR的OS与LT相当（P=0.13），但DFS仍然较差（HR =2.95；95%CI：2.30-3.79；P<0.01）。按地区划分，在北美和欧洲，LR的OS比LT差（P≤0.01），但在亚洲并非如此（P=0.25）。在2010年之前完成的研究中，LR的生存期比LT差（P=0.01），但在2010年之后并非如此（P=0.12）。接受强化监测的队列在LT和LR后的OS相当（P=0.33），但接受常规监测的队列在LR后的OS较差（HR =1.95；95%CI：1.24-3.07；P<0.01）。
结论
HCC患者LR后的死亡率比LT高近50%。单结节疾病中LR和LT的生存期相似。LR后复发风险是LT的三倍。
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