Kim Sooyeon, Lee Jungsue, Rim Chai Hong
College of Medicine, Korea University, Seoul 02841, Republic of Korea.
Department of Radiation Oncology, Korea University Ansan Hospital, Ansan 15355, Republic of Korea.
Cancers (Basel). 2023 Jul 2;15(13):3467. doi: 10.3390/cancers15133467.
Although recent studies have shown favorable results after local treatment for oligometastases, the clinical decision of applying local treatment for oligometastatic hepatocellular carcinoma (HCC) remains controversial. This meta-analysis aimed to investigate the benefits of local treatment for HCC oligometastases. Pubmed, Embase, Medline, and the Cochrane library were searched for studies until 1 May 2022. Clinical studies involving at least five cases of HCC oligometsatases treated with local modalities were included. The primary endpoint was overall survival (OS). The benefit of local treatment was assessed as the pooled odds ratio (OR) among comparative series, and the pooled OS percentile was calculated from all studies including patients treated with local treatment. Complications of grade ≥ 3 were assessed subjectively. A total of 10 studies involving 527 patients were included. Radiotherapy and radiofrequency ablation (RFA) were mainly performed (six and five studies) as local modalities treating oligometastases. Pooled OR of comparative series favored the use of local treatment (4.664, 95% confidence interval [CI]: 2.595-8.380, < 0.001, I: ~0.0%). Including all cohorts with patients who underwent local treatment, pooled rates of 1-year OS were 71.8% (95% CI: 59.0-81.9; I = 81.5%), and pooled 2-year OS were 43.3% (95% CI: 29.1-59.6; I = 85.4%). Except for temporal or pre-existing toxicities, grade ≤ 3 complications were reported less than 10% in most studies, although common toxicities include pneumothorax and hematologic deficiency after RFA and radiotherapy, respectively. Grade 5 toxicity has not yet been reported. This systematic review supports the application of local treatment for treating HCC oligometastases.
尽管最近的研究表明局部治疗寡转移灶后效果良好，但对于寡转移性肝细胞癌（HCC）应用局部治疗的临床决策仍存在争议。本荟萃分析旨在探讨局部治疗HCC寡转移灶的益处。检索了截至2022年5月1日的PubMed、Embase、Medline和Cochrane图书馆中的研究。纳入了至少有5例接受局部治疗的HCC寡转移灶的临床研究。主要终点是总生存期（OS）。局部治疗的益处评估为比较组间的合并比值比（OR），并从所有纳入接受局部治疗患者的研究中计算合并OS百分位数。主观评估≥3级并发症。共纳入10项研究，涉及527例患者。主要采用放疗和射频消融（RFA）（分别有6项和5项研究）作为治疗寡转移灶的局部治疗方式。比较组间的合并OR支持使用局部治疗（4.664，95%置信区间[CI]：2.595 - 8.380，P < 0.001，I²≈0.0%）。纳入所有接受局部治疗患者的队列，1年OS合并率为71.8%（95%CI：59.0 - 81.9；I² = 81.5%），2年OS合并率为43.3%（95%CI：29.1 - 59.6；I² = 85.4%）。除了暂时或既往存在的毒性外，大多数研究中≤3级并发症的报告率低于10%，尽管常见毒性分别包括RFA和放疗后的气胸和血液学缺乏。尚未报告5级毒性。本系统评价支持应用局部治疗来治疗HCC寡转移灶。
