Wang Jie, Hu Yanfeng, Zhou Lingyi, Yang Yanyan, Chen Junyu, Chen Hao, Wang Haibiao
Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, 315048, Zhejiang, China.
Department of General Surgery, Ninghai Chengguan Hospital, Ningbo, 315600, Zhejiang, China.
World J Surg Oncol. 2024 Dec 28;22(1):349. doi: 10.1186/s12957-024-03645-6.
There is ongoing debate surrounding the optimal therapeutic strategy for hepatocellular carcinoma (HCC) patients achieving complete response (CR) after conversion therapy. This meta-analysis compares the prognostic outcomes of non-surgery strategies with hepatectomy.
The systematic searches were conducted up to April 11, 2024, across PubMed, Embase, Web of Science, and the Cochrane Library, analyzing progression-free survival (PFS) and overall survival (OS). Subgroup analyses were conducted based on whether patients achieved a clinical CR or a radiologic CR, as well as the regimen of non-surgery strategy employed.
Six studies with 481 patients were identified. Non-surgery strategy was linked to significantly worse PFS compared to hepatectomy (hazard ratio [HR] = 2.15; 95% confidence interval [CI], 1.60 to 2.90). However, there was not a notable difference in OS between the two groups (HR = 1.35; 95% CI, 0.93 to 1.96). Subgroup analysis showed that for patients with clinical CR, there were no notable differences in both PFS and OS. Conversely, patients with radiologic CR experienced significantly worse PFS and OS when treated with non-surgery strategy.
Non-surgery strategy might provide comparable outcomes to hepatectomy for HCC patients with clinical CR, as opposed to those with radiologic CR. Further research is needed to confirm these results.
对于接受转化治疗后达到完全缓解（CR）的肝细胞癌（HCC）患者，最佳治疗策略一直存在争议。本荟萃分析比较了非手术策略与肝切除术的预后结果。
截至2024年4月11日，在PubMed、Embase、科学网和考克兰图书馆进行系统检索，分析无进展生存期（PFS）和总生存期（OS）。根据患者是否达到临床CR或放射学CR以及所采用的非手术策略方案进行亚组分析。
共纳入6项研究，481例患者。与肝切除术相比，非手术策略与显著更差的PFS相关（风险比[HR]=2.15；95%置信区间[CI]，1.60至2.90）。然而，两组之间的OS没有显著差异（HR=1.35；95%CI，0.93至1.96）。亚组分析表明，对于临床CR患者，PFS和OS均无显著差异。相反，放射学CR患者采用非手术策略治疗时，PFS和OS显著更差。
对于临床CR的HCC患者，非手术策略可能提供与肝切除术相当的结果，而对于放射学CR患者则不然。需要进一步研究来证实这些结果。
