Department of General Surgery, Yan'An Hospital Affiliated to Kunming Medical University, The Key Laboratory of Tumour Immunological Prevention and Treatment of Yunnan Province, Kunming, China.
Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
BJS Open. 2022 Mar 8;6(2). doi: 10.1093/bjsopen/zrac036.
The efficacy of repeat hepatic resection (rHR) in the treatment of recurrent hepatocellular carcinoma compared with radiofrequency or microwave ablation after resection of the primary tumour remains controversial. A systematic review and meta-analysis were performed to compare the safety and efficacy of these procedures.
PubMed, Embase, Scopus, Cochrane Library, and China National Knowledge Infrastructure databases were systematically searched to identify related studies published before 10 October 2021. Overall and recurrence-free survival after different treatments were compared based on pooled hazard ratios with a random-effects model.
Two randomized clinical trials and 28 observational studies were included, involving 1961 and 2787 patients who underwent rHR and ablation respectively. Median perioperative mortality in both groups was zero but patients in the rHR group had higher median morbidity rates (17.0 per cent) than those in the ablation group (3.3 per cent). rHR achieved significantly longer recurrence-free survival than ablation (HR 0.79, 95 per cent c.i. 0.70 to 0.89, P < 0.001), while both groups had similar overall survival (HR 0.93, 95 per cent c.i. 0.83 to 1.04, P = 0.18).
rHR and ablation based on radio- or microwaves are associated with similar overall survival in patients with recurrent hepatocellular carcinoma after resection of the primary tumour.
与原发性肿瘤切除后射频或微波消融相比，重复肝切除术（rHR）治疗复发性肝细胞癌的疗效仍存在争议。进行了系统评价和荟萃分析，以比较这些方法的安全性和疗效。
系统检索了 PubMed、Embase、Scopus、Cochrane 图书馆和中国国家知识基础设施数据库，以确定截至 2021 年 10 月 10 日之前发表的相关研究。根据随机效应模型汇总的风险比比较了不同治疗后的总生存率和无复发生存率。
纳入了 2 项随机临床试验和 28 项观察性研究，涉及分别接受 rHR 和消融的 1961 名和 2787 名患者。两组的围手术期死亡率中位数均为零，但 rHR 组的中位发病率（17.0%）高于消融组（3.3%）。rHR 的无复发生存率明显长于消融（HR 0.79，95%置信区间 0.70 至 0.89，P<0.001），而两组的总生存率相似（HR 0.93，95%置信区间 0.83 至 1.04，P=0.18）。
在原发性肿瘤切除后复发的肝细胞癌患者中，rHR 和基于射频或微波的消融与相似的总生存率相关。
