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1.
Claire L. Stevens Andrew Awad Saleh M. Abbas David A.K. Watters 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):653-658
Background
Surgical techniques and pre-operative patient evaluation have improved since the initial development of the Barcelona clinic liver cancer staging system. The optimal treatment for solitary hepatocellular carcinoma ≥5 cm remains unclear. The aim of this study was to review the long-term survival outcomes of hepatic resection versus transarterial chemoembolisation (TACE) for solitary large tumours.Methods
EMBASE, MEDLINE, Pubmed and the Cochrane database were searched for studies comparing resection with TACE for solitary HCC ≥5 cm. The primary outcome was overall survival at 1, 3 and 5 years.Results
The meta-analysis combined the results of four cohort studies including 861 patients where 452 underwent hepatic resection and 409 were treated with TACE to an absence of viable tumour. The pooled HR for 3 year OS rate calculated using the random effects model was 0.60 (95% CI 0.46–0.79, p < 0.001; I2 = 54%, P = 0.087). The pooled HR for 5 year OS rate calculated using the random effects model was 0.59 (95% CI 0.43–0.81, p = 0.001; I2 = 80%, P = 0.002).Conclusion
Hepatic resection has been shown to result in greater survivability and time to disease progression than TACE for solitary HCC ≥5 cm. Where a patient is fit for surgery, has adequate liver function and a favourable tumour, resection should be considered. 相似文献2.
Ze-Xin Zhu Xiao-Xue Wang Ke-Fei Yuan Ji-Wei Huang Yong Zeng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):795-802
Background
Hepatocellular carcinoma (HCC) is the most common malignancy in liver. Transarterial chemoembolization (TACE) is recommended as an effective treatment in advanced HCC patients. Recent studies showed iodine-125 seed (a low-energy radionuclide) can provide long-term local control and increase survival for HCC patients. The aim of the study was to evaluate the outcome of TACE plus iodine-125 seed in comparison with TACE alone for HCC.Methods
A comprehensive search of studies among PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted with published date from the earliest to January 10th, 2018. No language restrictions were applied, while only prospective randomized controlled trials (RCTs) or non-randomized controlled trials (non-RCTs) were eligible for a full-text review. The primary outcome was overall survival (OS), response rate (the rate of partial atrophy or complete clearance of the tumor lesion) and adverse events (AEs). The odds ratios (ORs) were combined using either fixed-effects model or random-effects model. All statistical analyses were performed using the Stata 12.0 software.Results
9 studies were included, involving 894 patients. Among them, 473 patients received combined therapy of TACE plus iodine-125 implantation, compared with 421 patients with TACE alone. Patients receiving combined therapy of TACE plus iodine-125 showed significantly improvement in 1-year OS (OR = 4.47, 95% confidence intervals (CI): 2.97–6.73; P < 0.001), 2-year OS (OR = 4.72, 95% CI: 2.63–8.47; P < 0.001). No significant publication bias was observed in any of the measured outcomes.Conclusions
Based on these findings, TACE plus iodine-125 implantation achieves better clinical efficacy compared with TACE alone in the treatment of HCC. 相似文献3.
Lei Liang Ting-Hao Chen Chao Li Hao Xing Jun Han Ming-Da Wang Han Zhang Wan Yee Lau Meng-Chao Wu Feng Shen Tian Yang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(12):1119-1129
Background
The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is very poor. According to most HCC guidelines, sorafenib, transarterial chemoembolization (TACE) or other non-surgical treatments are recommended as the first-line therapy for these patients. However, selected patients with HCC and PVTT can undergo surgical resection (SR). The aim of this meta-analysis was to compare the outcomes of SR with Non-SR for such patients.Methods
The PubMed, Embase, Medline and Cochrane library were searched for studies which compared SR with Non-SR for HCC and PVTT published before December 2017.Results
4810 patients from 7 studies who were enrolled in this meta-analysis were divided into the SR group (n = 2 344, 49%) and the Non-SR group (n = 2 476, 51%). The pooled hazard ratios (HRs) for the 1-, 3- and 5-year OS rates of the SR group when compared with the Non-SR group, were 0.57 (95% CI 0.48–0.67, P < 0.001), 0.66 (95% CI 0.56–0.77, P < 0.001) and 0.68 (95% CI 0.57–0.81, P < 0.001), respectively. On subgroup analysis, the pooled HRs for the 1-, 3- and 5-year OS rates of the SR group when compared with the TACE group, were 0.62 (95% CI 0.54–0.71, P < 0.001), 0.74 (95% CI 0.66–0.83, P < 0.001) and 0.78 (95% CI 0.70–0.87, P < 0.001), respectively.Conclusion
This meta-analysis showed SR resulted in better OS than TACE, or other Non-SR treatments, for patients with HCC and PVTT. SR should be considered in selected patients with resectable HCC and PVTT. 相似文献4.
Chetana Lim Chady Salloum Michael Osseis Eylon Lahat Concepción Gómez-Gavara Philippe Compagnon Alain Luciani Cyrille Feray Daniel Azoulay 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(3):222-230
Background
Western guidelines recommend resection for hepatocellular carcinoma (HCC) in so-called ideal cirrhotic patients with a Barcelona Clinic Liver Cancer (BCLC) stage 0-A tumour. This study compares short-term outcomes following resection between patients defined as ideal and nonideal according to the BCLC guidelines.Methods
This prospective single-centre open study (ClinicalTrials.govNCT02145013) included all cirrhotic patients with HCC referred for resection from 2014 to 2016. Mortality, morbidity, unresolved liver decompensation, and readmission were measured.Results
The study population included 65 consecutive patients: 32 (49%) ideal and 33 (51%) nonideal. Ideal and nonideal groups did not differ in mortality (3% vs. 6%; p = 0.57), morbidity (53% vs. 73%; p = 0.10), or unresolved liver decompensation (6% vs. 15%; p = 0.23) at 90 days. The readmission rate was higher in the nonideal (21%) than in the ideal group (3%; p = 0.02).Conclusion
Straying from the current guidelines for resection in a selected subset of nonideal patients doubled the number of resections performed for treating HCC, with satisfactory short-term outcomes. These results argue for the expansion of the acknowledged BCLC guidelines. 相似文献5.
Malay Shukla Jae-Hyeong Park James D. Thomas Victoria Delgado Jeroen J. Bax Garvan C. Kane Jonathan G. Howlett James A. White Nowell M. Fine 《The Canadian journal of cardiology》2018,34(8):1069-1078
Background
Right ventricular (RV) strain imaging using speckle-tracking echocardiography (STE) is a quantitative method of assessing RV systolic function that has shown prognostic utility in patients with pulmonary hypertension (PH). However, its prognostic value for a large and mixed PH population remains poorly defined.Methods
A systematic review and meta-analysis was performed using the MedLine, Embase, and Cochrane Library databases for publications reporting the prognostic value of RV strain calculated using 2-dimensional STE in PH patients for the clinical end point of all-cause mortality.Results
Screening of 687 publications yielded 10 that were included in the meta-analysis, representing data for 1001 PH patients, among whom 76% had pulmonary arterial hypertension with the remainder having a range of PH etiologies. The pooled free wall RV strain was ?16.2% (95% confidence interval [CI], ?14.3 to ?18.1; I2 = 94.1%; Q = 102.8; P < 0.001), and the global (free wall and septum) RV strain was ?14.5% (95% CI, ?12.9 to ?16; I2 = 84.9%; Q = 20; P < 0.001). There were 193 (18%) deaths (follow-up period range, 7.4 months to 4.2 years). From 6 publications, the pooled unadjusted hazard ratio for a binary cut off RV strain value for the primary outcome was 3.67 (95% CI, 2.82-4.77; P < 0.001; I2 = 0; Q = 1.8; P = 0.87), whereas the pooled unadjusted hazard ratio of RV strain as a continuous variable (per 1% change) was 1.14 (95% CI, 1.11-1.8; P < 0.001; I2 = 0; Q = 2.0; P = 0.85), and were superior to corresponding values for tricuspid annular systolic plane excursion (1.45; P = 0.071, hazard ratio = 1.00, and P = 0.82, respectively).Conclusions
RV strain performed using 2-dimensional STE provides important prognostic value within a large and mixed population of PH patients. 相似文献6.
Guanghua Liu Qiang Ouyang Fang Xia Guoping Fan Juming Yu Caiyuan Zhang Dengbin Wang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):107-113
Background
To investigate the clinical value of the alpha-fetoprotein (AFP) response following transcatheter arterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC).Methods
Data on patients with Barcelona Clinic Liver Cancer B staging system were analyzed. An AFP response was defined as a decrease in AFP of more than 20% after a TACE session. The association between AFP response and treatment outcome regarding imaging response and overall survival (OS) was explored. Cox proportional hazards models were applied to identify independent risk factors for OS after TACE.Results
Of the enrolled 376 patients with elevated serum AFP >20 ng/mL, 214 (57%) with AFP responses were identified. AFP responders had improved median survival than non-responders (20 vs. 12 months, P = 0.002). AFP response was significantly correlated with imaging response (P < 0.001). The Cox proportional hazards model revealed that AFP response was an independent factor for OS (hazard ratio, 0.59; 95% confidence interval, 0.45–0.78; P < 0.001). In stratified analyses, an AFP response achieved improved survival in patients with tumor diameters ≤5 cm, diameters >5 cm, tumor number ≤3 and without underlying cirrhosis.Conclusions
The AFP response indicates enhanced survival after TACE in patients with intermediate-stage BCLC. 相似文献7.
Shuangxi Li Xuewen He Lei Dang Fangyu Xu Jin Fang Fenqiang Li Wenhui Wang 《Digestive diseases and sciences》2018,63(2):321-328
Purpose
To compare the therapeutic effects of 125I versus non-125I combined with transcatheter arterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) with obstructive jaundice.Methods
A retrospective analysis was conducted using the records of 54 consecutive patients who were initially diagnosed with HCC with obstructive jaundice between May 2009 and July 2016. Twenty-one cases (group A) were treated with percutaneous transhepatic biliary drainage (PTBD) followed by 125I radioactive seed strip implantation through the PTBD tube. After the total serum bilirubin level was reduced to normal and the liver function recovered to Child–Pugh class A or early B, TACE was conducted. In 33 cases (group B) PTBD was performed in combination with TACE without applying the 125I radioactive seeds. The duration of biliary patency and survival were analyzed.Results
The technical success rate in both groups was 100%. The median biliary patency time was 6.000 ± 0.315 months (95% CI 5.382–6.618 months) in group A and 4.000 ± 0.572 months (95% CI 2.879–5.121 months) in group B; the two groups were significantly different (P = 0.001). The median survival was 11.000 ± 0.864 months (95% CI 9.306–12.694 months) in group A and 9.000 ± 0.528 months (95% CI 7.965–10.035 months) in group B; the two groups were significantly different (P = 0.022).Conclusions
The combination of 125I with TACE was more effective than TACE without the radioactive seeds for treating patients with unresectable HCC with obstructive jaundice. Future prospective trials with larger samples will be required to validate these results.8.
Qi-Han Fu Qi Zhang Xue-Li Bai Qi-Da Hu Wei Su Yi-Wen Chen Ri-Ga Su Ting-Bo Liang 《Journal of cancer research and clinical oncology》2014,140(8):1429-1440
Background and aim
Combination therapy of sorafenib and transarterial chemoembolization (TACE) showed benefits for hepatocellular carcinoma (HCC). This systematic review aims for evaluation of efficacy and safety between sorafenib plus TACE and TACE alone for HCC.Methods
We systematically searched multi-databases to identify eligible studies. Studies comparing sorafenib combined with TACE and TACE alone for HCC were included.Results
Nine studies with 900 patients (sorafenib + TACE = 446, TACE = 454) were finally included. Sorafenib combined with TACE significantly reduced 6-month mortality [OR 0.24, 95 % confidential interval (CI) 0.09–0.68, P = 0.007] and 1-year mortality (OR 0.35, 95 % CI 0.21–0.56, P < 0.0001), but did not decrease 2-year mortality (OR 0.58, 95 % CI 0.14–2.46, P = 0.46). Although combination therapy tend to reduce 3-month (OR 0.76, 95 % CI 0.52–1.10, P = 0.15) and 6-month progression free rate (OR 0.27, 95 % CI 0.07–1.05, P = 0.06), the changes were not significant. Additionally, objective response ratio (OR 0.39, 95 % CI 0.19–0.78, P = 0.008) and clinical benefit ratio (OR 0.27, 95 % CI 0.15–0.50, P < 0.0001) also favored for combination therapy, which, however, caused higher morbidity, especially hand-foot skin reaction (OR 53.71, 95 % CI 28.86–99.93, P < 0.00001), hematological events (OR 14.8, 95 % CI 6.07–36.07, P < 0.00001), diarrhea (OR 6.62, 95 % CI 3.82–11.45, P < 0.00001), hypertension (OR 5.03, 95 % CI 3.02–8.38, P < 0.00001), rash/desquamation (OR 5.67, 95 % CI 3.58–8.99, P < 0.00001), and fatigue (OR 2.5, 95 % CI 1.09–5.72, P = 0.03).Conclusion
Combination of sorafenib and TACE showed survival and clinical benefits in patients with HCC, though enhanced morbidity. 相似文献9.
Yanming Zhou Bin Shi Lupeng Wu Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):10-15
Background
To assess the published evidence on clinical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS) for adenocarcinoma in the body or tail of the pancreas.Method
PubMed and Chinese Biomedical Literature databases were searched. The results of comparisons between RAMPS and standard retrograde pancreatosplenectomy (SRPS) were analyzed by meta-analytical techniques.Results
The literature search identified 13 observational studies involving 354 patients undergoing RAMPS. The overall morbidity and 30-day mortality was 40% and 0% respectively. The R0 resection rate was 88%; the median number of retrieved lymph nodes was 21; and the median 5-year overall survival rate was 37%. The result of meta-analysis showed that RAMPS was associated with a significantly less intraoperative bleeding [weighted mean difference ?195.2 (95% confidence interval (CI) ?223.27 to ?167.13); P < 0.001], a greater number of retrieved lymph nodes [odds ratio (OR) 6.19 (95% CI 3.72 to 8.67); P < 0.001] and a higher percentage of R0 resection [OR 2.46 (95% CI 1.13 to 5.35); P = 0.02] as compared with SRPS.Conclusion
The current literature provides supportive evidence that RAMPS is a safe and effective procedure for adenocarcinoma in the body or tail of the pancreas, and is oncologically superior to SRPS. 相似文献10.
Background
Recent studies suggest that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have a synergistic effect for hepatocellular carcinoma (HCC).Aims
The aim of this meta-analysis was to compare the effectiveness of combination of RFA and TACE with that of RFA alone in patients with HCC.Methods
Randomized controlled trials and retrospective cohort studies comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. Study quality was rated with a standardized scale and the strength of evidence was also rated by using the grading of recommendations assessment, development, and evaluation system (GRADE system).Results
Meta-analyses showed that the combination of RFA and TACE was obviously associated with higher survival rates (odds ratio [OR]1-year = 2.14, 95 % confidence interval [95 % CI] 1.57–2.91, P < 0.001; OR3-year = 1.98, 95 % CI 1.28–3.07, P = 0.001; OR5-year = 2.70, 95 % CI 1.42–5.14, P = 0.003). The overall quality of evidence was judged to be low by using the GRADE system.Conclusions
The combination of TACE with RFA can improve the overall survival rate and provides better prognosis for patients with HCC, but more randomized controlled trials using large sample size are needed to provide sufficient evidence. 相似文献11.
Tyrone G. Harrison Helen Tam-Tham Brenda R. Hemmelgarn Meghan Elliott Matthew T. James Paul E. Ronksley Min Jun 《The Canadian journal of cardiology》2019,35(1):77-91
Background
There is ongoing controversy around the surrogacy of proteinuria or albuminuria, particularly for cardiovascular (CV) outcomes, which remain the leading cause of morbidity and mortality among patients with chronic kidney disease. We performed a systematic review and meta-analysis of the literature to assess the surrogacy of changing proteinuria or albuminuria for CV events, end-stage renal disease (ESRD), and all-cause mortality.Methods
CENTRAL, EMBASE, and MEDLINE were searched (from inception to October 2017). All randomized controlled trials in adults that reported change in proteinuria or albuminuria and ≥ 10 CV, ESRD, or all-cause mortality events were included. We calculated treatment effect ratios (TERs), defined as the ratio of the treatment effect on a clinical outcome and the effect on the change in the surrogate outcome. TERs close to 1 indicate greater agreement between the clinical outcome and changing proteinuria or albuminuria.Results
Thirty-six trials were included in the meta-analysis. We observed inconsistent treatment effects for proteinuria and CV events (20 trials; TER 1.11 [95% confidence interval (CI), 1.01-1.22]) with moderate heterogeneity (I2 = 51%, P = 0.005). Treatment effects on proteinuria or albuminuria were also inconsistent with the effects on all-cause mortality (21 trials; TER 1.17 [95% CI, 1.07-1.28]; I2 = 35%, P for heterogeneity = 0.06), although they were similar with the effects on ESRD (23 trials; TER 0.99 [95% CI, 0.88-1.13]; I2 = 9%, P for heterogeneity = 0.337).Conclusions
Change in proteinuria or albuminuria might be a suitable surrogate outcome for ESRD. However, overall treatment effects on these potential surrogates are inconsistent and overestimate the treatment effects on CV events and all-cause mortality. 相似文献12.
Jia-yan Ni Shan-shan Liu Lin-feng Xu Hong-liang Sun Yao-ting Chen 《Journal of cancer research and clinical oncology》2013,139(4):653-659
Purpose
This meta-analysis was designed to compare the effectiveness of the combination of transarterial chemoembolization (TACE) and percutaneous radiofrequency ablation (PRFA) with that of TACE and PRFA monotherapy in hepatocellular carcinoma (HCC).Methods
Randomized controlled trials were searched using various databases, and six studies were revealed on comparing TACE plus PRFA with TACE and/or PRFA alone for the treatment for HCC. Overall survival rate and recurrence-free survival rate were analyzed and compared. All statistic analyses were conducted using Review Manager (version 4.2.2.) from the Cochrane collaboration.Results
Meta-analysis data revealed that TACE plus PRFA had significantly better effectiveness on 1- and 3-year overall survival rate(odds ratio [OR] 1-year = 4.61, 95 % confidence interval [95 % CI] 2.26–9.42, P < 0.0001; OR 3-year = 2.79, 95 % CI 1.69–4.61, P < 0.0001) and 3-year recurrence-free survival rate ([OR] 3-year = 3.00, [95 % CI] 1.75–5.13, P < 0.0001) than that of TACE and/or PRFA alone treatment. There was no significant difference between the combined therapy and monotherapy on 1-year recurrence-free survival rate ([OR] 1-year = 1.55, [95 % CI] 0.91–2.65, P = 0.11).Conclusions
The data of our study indicate that the combination of TACE and PRFA has better effectiveness than that of TACE and PRFA monotherapy in the treatment for patients with HCC. 相似文献13.
Background
Recent studies suggest that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have a synergistic effect for hepatocellular carcinoma (HCC).Aims
The aim of this meta-analysis was to compare the effectiveness of combination of RFA and TACE with that of RFA alone in patients with HCC.Methods
Randomized controlled trials and retrospective cohort studies comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. Study quality was rated with a standardized scale and the strength of evidence was also rated by using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE system).Results
Meta-analyses showed that the combination of RFA and TACE was obviously associated with higher survival rates (OR1-year = 2.06, 95 % CI 1.46–2.91, P < 0.001; OR3-year = 1.93, 95 % CI 1.18–3.15, P = 0.009; OR5-year = 1.87, 95 % CI 1.23–2.83, P = 0.003). The overall quality of the evidence was judged to be low by using the GRADE system.Conclusions
The combination of TACE with RFA can improve the overall survival rate and provides better prognosis for patients with HCC, but more randomized controlled trials using large sample sizes are needed to provide sufficient evidence. 相似文献14.
Derrick Y. Tam Bobby Yanagawa Subodh Verma Marc Ruel Stephen E. Fremes Amine Mazine Seana Adams Jan O. Friedrich 《The Canadian journal of cardiology》2018,34(9):1185-1199
Background
Surgical timing in infective endocarditis (IE) with preoperative neurological events remains controversial. The relevant society guidelines are each on the basis of a small number of observational studies. This meta-analysis was designed to search the available literature broadly and assess the weight of available evidence as comprehensively as possible.Methods
We searched MEDLINE and EMBASE to April 2018 for studies that compared mortality or neurological exacerbation in early vs late surgery for IE complicated by neurological events. Random effects meta-analysis was performed.Results
Twenty-seven observational studies (25 unadjusted, n = 879; 2 adjusted, n = 451) met inclusion criteria. Using early and late thresholds defined in each study (7 or 14 days), early surgery in ischemic or hemorrhagic stroke was associated with elevated perioperative mortality vs late surgery (pooled relative risk [RR], 1.74; 95% confidence interval, 1.34-2.25; P < 0.0001; I2 = 0%) and greater neurological exacerbation (RR, 2.09; 95% confidence interval, 1.32-3.32; P = 0.002; I2 = 33%). In subgroup analysis, for ischemic stroke, early surgery before 7 vs before 14 days exhibited similar perioperative mortality and neurological exacerbation. For hemorrhagic stroke, performing surgery before 21 vs before 28 days showed trends toward perioperative mortality (RR, 1.77 vs 0.63, interaction P = 0.14) and neurological (RR, 2.02 vs RR, 0.44; interaction P = 0.11) exacerbation. There was no difference in long-term mortality but reporting was sparse. Early surgery was often performed for clinical deterioration, negatively biasing outcomes.Conclusions
Available observational data support delaying surgery by 7-14 days if possible in IE complicated by ischemic stroke and > 21 days in hemorrhagic stroke to decrease perioperative mortality and neurological exacerbation rates. Randomized trials are needed for definitive guidance. 相似文献15.
Lili Gu Huiling Liu Linlin Fan Yuanjun Lv Zhuang Cui Yan Luo Yuanyuan Liu Guang Li Changping Li Jun Ma 《Journal of cancer research and clinical oncology》2014,140(2):199-210
Purpose
To evaluate the effectiveness comparing the combination of TACE with local ablative therapy and monotherapy on the treatment of HCC using meta-analytical techniques.Methods
Randomized controlled trials and clinical studies comparing TACE plus local ablative therapy with monotherapy for HCC were included in this meta-analysis. Response rate, 1-, 2-, 3-, and 5-year survival rate, and overall survival (OS) were analyzed and compared.Results
Eighteen studies included a total of 2,120 patients with HCC 1,071 and 1,049 patients for treatment with combination therapy and monotherapy, respectively. The combination therapy group had a significantly better survival in terms of 1-, 2-, 3-, and 5-year survival rate (RR 1.10, 95 % CI 1.03–1.18, P = 0.005; RR 1.20, 95 % CI 1.10–1.30, P < 0.0001; RR 1.43, 95 % CI 1.18–1.73, P < 0.0001; RR 1.40, 95 % CI 1.22–1.61, P < 0.0001, respectively), OS (HR 0.66, 95 % CI 0.51–0.85, P = 0.001), and response rate (RR 1.54, 95 % CI 1.09–2.18, P = 0.013) than that monotherapy group in patients with HCC.Conclusions
The meta-analysis indicates that the combination of TACE with local ablative therapy was superior to monotherapy in the treatment for patients with HCC. 相似文献16.
Yanming Zhou Lupeng Wu Dong Xu Tao Wan Xiaoying Si 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):768-774
Background
Limited data are currently available to address the safety and efficacy of combined resection of the liver and inferior vena cava (IVC) for hepatic malignancies.Methods
A systematic review was performed to identify relevant studies. Pooled individual data were examined for the clinical outcome of combined resection of the liver and IVC for hepatic malignancies.Results
A total of 258 patients were described in 38 articles eligible for inclusion. Resections were performed for colorectal liver metastasis (CLM) [n = 128 (50%)], intrahepatic cholangiocarcinoma (ICC) [n = 51 (20%)], hepatocellular carcinoma (HCC) [n = 48 (19%)], and other pathologies [n = 31 (11%)]. There were 14 (5%) perioperative deaths. The median survival duration was 34 months, and the 1-, 3- and 5-year overall survival (OS) rate was 79%, 46% and 33%, respectively. The 5-year OS rate was 26% for CLM, 37% for ICC, and 30% for HCC.Conclusion
Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes. 相似文献17.
Zhongran Man Qing Pang Lei Zhou Yong Wang Xiaosi Hu Song Yang Hao Jin Huichun Liu 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):888-895
Background
To date, epidemiological evidence of the association between preoperative prognostic nutritional index (PNI) and the prognosis of hepatocellular carcinoma (HCC) remains controversial.Methods
A literature search was performed in the databases of PubMed, Embase, and Web of Science. Hazard ratio (HR), odds ratio (OR), and 95% confidence interval (CI) were extracted to estimate the association of preoperative PNI with overall survival (OS), disease-free survival (DFS), and postoperative recurrence of HCC, respectively. A random-effects model was used to calculate the pooled effect size.Results
Thirteen studies with a total of 3,738 patients with HCC met inclusion criteria for this meta-analysis. It indicated that a lower level of preoperative PNI was a significant predictor of worse OS (HR = 1.82, 95%CI: 1.44-2.31) and DFS (HR = 1.49, 95% CI: 1.06-2.07). In addition, risk of postoperative recurrence was significantly higher in patients with a lower preoperative PNI (OR = 1.92, 95% CI: 1.33-2.76). Subgroup analysis based on therapeutic intent demonstrated a significant positive association between preoperative low PNI and worse OS for those patients undergoing surgical resection and for those undergoing TACE or non-surgical treatment.Conclusion
The current meta-analysis demonstrates that preoperative PNI is a prognostic marker in HCC. 相似文献18.
Seiji Oguro Jiro Yoshimoto Hiroshi Imamura Yoichi Ishizaki Seiji Kawasaki 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(9):872-880
Background
Hepatectomy with a sufficient margin is often impossible for hepatocellular carcinomas that are close to the large intrahepatic vascular structures, and macroscopically complete resection along the tumor capsule is the only choice. The aim of this retrospective study was to evaluate the clinical significance of macroscopic no-margin hepatectomy (MNMH).Methods
Among patients undergoing macroscopically curative resection for untreated hepatocellular carcinoma, outcomes were compared between patients undergoing MNMH (n = 87) and those undergoing hepatectomy with a macroscopic margin (n = 192).Results
MNMH was significantly associated with a longer operation time (P < 0.001), greater intraoperative blood loss (P < 0.001), a greater need for blood transfusion (P = 0.018), a higher incidence of major postoperative complications (P = 0.031), multiple tumors (P = 0.015), tumor capsule formation (P = 0.030), and a microscopically positive surgical margin (P = 0.021). There was no significant difference between the groups in terms of recurrence-free survival (P = 0.946) and overall survival (P = 0.259).Discussion
MNMH is technically demanding and results more frequently in a microscopically positive surgical margin, however, it can yield a long-term outcome comparable to hepatectomy with a macroscopic margin even in patients with otherwise unresectable hepatocellular carcinoma. 相似文献19.
Michelle Welsford Matthias Bossard Colleen Shortt Jodie Pritchard Madhu K. Natarajan Emilie P. Belley-Côté 《The Canadian journal of cardiology》2018,34(2):180-194
Background
In patients with out-of-hospital cardiac arrest who achieve return of spontaneous circulation, coronary angiography (CAG) might improve outcomes. We conducted a systematic review and meta-analysis to elucidate the benefit and optimal timing of early CAG in comatose out-of-hospital cardiac arrest patients with return of spontaneous circulation.Methods
We searched MEDLINE, EMBASE, and Cochrane from 1990 to May 2017. Studies reporting survival and/or neurological survival in early (< 24-hour) vs late/no CAG were selected. We used the Clinical Advances Through Research and Information Translation (CLARITY) risk of bias in cohort studies tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria to assess risk of bias and quality of evidence, respectively. Results were pooled using random effects and presented as risk ratios (RRs) with 95% confidence intervals (CIs).Results
After screening 9185 titles/abstracts and 631 full-text articles, we included 23 nonrandomized studies. Short (to discharge or 30 days) and long-term (1-5 years) survival were significantly improved (52% and 56%, respectively) in the early < 24-hour CAG group compared with the late/no CAG group (RR, 1.52; 95% CI, 1.32-1.74; P < 0.00001; I2, 94% and RR, 1.56; 95% CI, 1.14-2.14; P = 0.006; I2, 86%). Survival with good neurological outcome was also improved by 69% in the < 24-hour CAG group at short- (RR, 1.69; 95% CI, 1.40-2.04; P < 0.00001; I2, 93%) and intermediate-term (3-11 months; RR, 1.49; 95% CI, 1.27-1.76; P < 0.00001; I2, 67%). We found consistent benefits in the < 2-hour and < 6-hour subgroups. Early CAG was associated with significantly better outcomes in studies of patients without ST-elevation, but the results did not reach statistical significance in studies of patients with ST-elevation.Conclusions
On the basis of very low quality, but consistent evidence, early CAG (< 24 hours) was associated with significantly higher survival and better neurologic outcomes. 相似文献20.
Jack P. Silva Nicholas G. Berger Susan Tsai Kathleen K. Christians Callisia N. Clarke Harveshp Mogal Sarah White William Rilling T. Clark Gamblin 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(8):659-666