Chuncharunee Alan, Oranratnachai Songporn, Chuncharunee Lancharat, Intaraprasong Pongphob, Thakkinstian Ammarin, Sobhonslidsuk Abhasnee
Division of Gastroenterology and Hepatology, Department of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand.
Department of Clinical Epidemiology and Biostatistics Mahidol University Bangkok Thailand.
JGH Open. 2024 Jul 8;8(7):e13111. doi: 10.1002/jgh3.13111. eCollection 2024 Jul.
Liver transplantation (LT) is essential due to its curative efficacy, but liver-graft shortages have limited its widespread application. Bridging locoregional therapy (LRT) before LT has been performed to prevent tumor progression, and a recent literature review revealed that it is associated with a nonsignificant trend toward better survival outcomes. However, much more information on bridging therapy has become available since then. This meta-analysis aimed to compare the posttransplant survival and HCC recurrence between patients with and without pretransplant bridging LRT.
Studies were identified in MEDLINE, SCOPUS, and the Cochrane Library. Two independent researchers screened titles and full articles, extracted relevant data, and conducted a parametric survival analysis.
Out of 4794 studies, 18 cohort studies were eligible. The 1-, 3-, and 5-year overall survival (OS) rates were 93.1%, 85.0%, and 79.1% for those in the bridging LRT group, while they were 91.8%, 81.1%, and 75.5% for those who did not receive LRT, respectively. There were no differences in overall survival between these groups (HR 0.90; 0.78-1.05, P = 0.17). Interestingly, we discovered that bridging therapy helped prolong survival significantly in a high-risk population with a long waiting time (HR 0.76; 0.60-0.96, P = 0.02). Unfortunately, bridging LRT did not improve disease-free survival (HR 0.98; 0.86-1.11, P = 0.70).
The results indicate that bridging LRT does not generally change post-LT outcomes. However, bridging LRT can significantly improve survival in patients with a long waiting time for LT.
肝移植（LT）因其治愈效果至关重要，但肝移植供体短缺限制了其广泛应用。在肝移植前进行局部区域治疗（LRT）以预防肿瘤进展，最近的一项文献综述显示，这与生存结局改善的趋势不显著相关。然而，自那时以来，关于桥接治疗的更多信息已经出现。这项荟萃分析旨在比较接受和未接受移植前桥接LRT的患者移植后的生存率和肝癌复发情况。
在MEDLINE、SCOPUS和Cochrane图书馆中检索研究。两名独立研究人员筛选标题和全文，提取相关数据，并进行参数生存分析。
在4794项研究中，有18项队列研究符合条件。桥接LRT组患者的1年、3年和5年总生存率（OS）分别为93.1%、85.0%和79.1%，而未接受LRT的患者分别为91.8%、81.1%和75.5%。这些组之间的总生存率没有差异（HR 0.90；0.78 - 1.05，P = 0.17）。有趣的是，我们发现桥接治疗有助于显著延长等待时间长的高危人群的生存期（HR 0.76；0.60 - 0.96，P = 0.02）。不幸的是，桥接LRT并未改善无病生存率（HR 0.98；0.86 - 1.11，P = 0.70）。
结果表明，桥接LRT一般不会改变肝移植后的结局。然而，桥接LRT可以显著提高等待肝移植时间长的患者的生存率。
