Wang Chunling, Huang Xiaozhun, Lan Xiaofeng, Lan Dongmei, Huang Zhangkan, Ye Shu, Ran Yihong, Bi Xinyu, Zhou Jianguo, Che Xu
Department of Hospital-Acquired Infection Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Front Oncol. 2022 Sep 29;12:973857. doi: 10.3389/fonc.2022.973857. eCollection 2022.
Spontaneously ruptured hepatocellular carcinoma (rHCC) with hemorrhage is characterized by rapid onset and progression. The aim of this systematic review was to explore the current studies on rHCC with hemorrhage and determine the optimum treatment strategy.
The PubMed, Web of Science, Embase, and the Cochrane Library databases were searched for studies reporting survival outcomes with comparison between emergency resection (ER) and transarterial embolization following staged hepatectomy (SH) were included by inclusion and exclusion criteria, the perioperative and survival data were statistically summarized using Review Manager 5.3 software.
A total of 8 retrospective studies were included, with a total sample size of 556, including 285 (51.3%) in the ER group and 271 (48.7%) in the SH group. The perioperative blood loss and blood transfusion volume in the SH group were less than those in the ER group, and there were no significant differences in the operative time, incidence of complications, mortality and recurrence rate of tumors between the two groups. The 1-, 2-, 3-year overall survival and 1-, 2-, 3-, 5-year disease-free survival of the ER group were not significantly different from those of the SH group, and the 5-year overall survival rate of ER group was lower than that of the SH group (hazard ratios=1.52; 95% confidence intervals: 1.14-2.03, P=0.005).
There was no significant difference in the short-term efficacy of ER or SH in the treatment of ruptured HCC, and SH was superior to ER in the long-term survival.
自发性破裂出血性肝细胞癌（rHCC）起病急、进展快。本系统评价旨在探讨目前关于rHCC伴出血的研究，并确定最佳治疗策略。
检索PubMed、Web of Science、Embase和Cochrane图书馆数据库，纳入报告急诊切除（ER）与分期肝切除（SH）后经动脉栓塞术对比生存结局的研究，根据纳入和排除标准筛选研究，使用Review Manager 5.3软件对围手术期和生存数据进行统计学汇总。
共纳入8项回顾性研究，总样本量为556例，其中ER组285例（51.3%），SH组271例（48.7%）。SH组围手术期失血量和输血量少于ER组，两组手术时间、并发症发生率、死亡率和肿瘤复发率无显著差异。ER组1年、2年、3年总生存率及1年、2年、3年、5年无病生存率与SH组无显著差异，ER组5年总生存率低于SH组（风险比=1.52；95%置信区间：1.14 - 2.03，P = 0.005）。
ER或SH治疗破裂性HCC的短期疗效无显著差异，SH在长期生存方面优于ER。
