胆管癌肝移植有效性与安全性的meta分析

目的 评估胆管癌患者肝移植的有效性和安全性.方法 检索1995年至2009年相关英文文献,对符合纳入标准的临床试验用Stata 10软件对其1、3、5年有效生存率及并发症发生率进行meta分析.结果 有14项独立的临床研究的17篇文献入组,共纳入605例胆管癌肝移植患者.1、3、5年总体有效生存率分别为73%(95%CI:0.65～0.80)、42%(95%CI:0.33～0.51)和39%(95%CI:0.28～0.51).其中,新辅助放化疗组(OLT-PAT组)的1、3、5年有效生存率达到83%(95%CI:0.57～0.98)、57%(95%CI:0.18～0.92)和65%(95%CI:0.40～0.87).并发症总体有效发生率为62%(95%CI:0.44～0.78).与单纯肝移植组(61%,95%CI:0.33～0.85)和肝移植合并部分胰十二指肠切除组(78%,95%CI:0.55～0.94)相比,OLT-PAT组(58%,95%CI:0.20～0.92)的并发症有效发生率可以接受.结论 与传统手术局部切除治疗胆管癌5年生存率比较,肝移植治疗胆管癌的总体有效率并无明显优势;新辅助放化疗联合肝移植治疗胆管癌的近、远期有效生存率较高.

Abstract：

Objective To evaluate the therapeutic efficacy and safety of liver transplantation for patients with cholangiocarcinoma. Methods According to the requirements of Cochrane systematic review, a thorough literature search was performed in Pubmed/Medline, Embase and Cochrane Central Register electronic databases ranged between 1995 and 2009 in terms of the key words "liver transplantation", and "cholangiocarcinoma" or "cholangiocellular carcinoma" or "bile duct cancer" . And restricted the articles published in the English language. Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies with confirmation by cross-checking.Data were processed for a meta-analysis by Stata 10 software with 1-, 3-, 5-year survival rates and incidence of complications. Results A total of 14 clinical trials containing 605 patients were finally enrolled in this study. The overall 1-, 3-, 5-year pooled survival rates were 73% (95% CI: 0. 65 -0. 80), 42% (95% CI:0. 33 -0. 51 ) and 39% (95% CI: 0. 28 - 0. 51 ), respectively. Of note, preoperative adjuvant therapies (OLT-PAT group) rendered the transplanted individuals comparably favorable outcomes with 1-, 3-, 5-year pooled survival rates of 83 % (95 % CI: 0. 57 - 0. 98 ), 57 % ( 95 % CI: 0. 18 - 0. 92 ) and 65 % ( 95 % CI:0. 40 -0. 87), respectively. In addition, the overall pooled incidence of complications was 62% (95% CI:0. 44 - 0. 78 ), among which that of OLT-PAT group ( 58%, 95% CI: 0. 20 - 0. 92 ) was relatively acceptable compared to those of liver transplantation alone (61%, 95% CI: 0. 33 - 0. 85 ) and liver transplantation with extended bile duct resection ( 78%, 95% CI:0.55-0.94). Conclusions In comparison to curative resection of cholangiocarcinoma with the 5-year survival rate reported from 20% to 40%, the role of liver transplantation alone is so limited, but neoadjuvant radiochemotherapy combined with liver transplantation can bring better short- and long-term prognosis.

Meta-analysis of efficacy and safety of liver transplantation in treating cholangiocarcinoma

Objective To evaluate the therapeutic efficacy and safety of liver transplantation for patients with cholangiocarcinoma. Methods According to the requirements of Cochrane systematic review, a thorough literature search was performed in Pubmed/Medline, Embase and Cochrane Central Register electronic databases ranged between 1995 and 2009 in terms of the key words "liver transplantation", and "cholangiocarcinoma" or "cholangiocellular carcinoma" or "bile duct cancer" . And restricted the articles published in the English language. Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies with confirmation by cross-checking.Data were processed for a meta-analysis by Stata 10 software with 1-, 3-, 5-year survival rates and incidence of complications. Results A total of 14 clinical trials containing 605 patients were finally enrolled in this study. The overall 1-, 3-, 5-year pooled survival rates were 73% (95% CI: 0. 65 -0. 80), 42% (95% CI:0. 33 -0. 51 ) and 39% (95% CI: 0. 28 - 0. 51 ), respectively. Of note, preoperative adjuvant therapies (OLT-PAT group) rendered the transplanted individuals comparably favorable outcomes with 1-, 3-, 5-year pooled survival rates of 83 % (95 % CI: 0. 57 - 0. 98 ), 57 % ( 95 % CI: 0. 18 - 0. 92 ) and 65 % ( 95 % CI:0. 40 -0. 87), respectively. In addition, the overall pooled incidence of complications was 62% (95% CI:0. 44 - 0. 78 ), among which that of OLT-PAT group ( 58%, 95% CI: 0. 20 - 0. 92 ) was relatively acceptable compared to those of liver transplantation alone (61%, 95% CI: 0. 33 - 0. 85 ) and liver transplantation with extended bile duct resection ( 78%, 95% CI:0.55-0.94). Conclusions In comparison to curative resection of cholangiocarcinoma with the 5-year survival rate reported from 20% to 40%, the role of liver transplantation alone is so limited, but neoadjuvant radiochemotherapy combined with liver transplantation can bring better short- and long-term prognosis.