肝细胞癌合并微血管侵犯肝切除术后辅助性TACE疗效的荟萃分析

目的评价肝切除术后经导管肝动脉栓塞化疗(TACE)对肝细胞癌合并微血管侵犯患者预后的影响°方法检索PubMedACochrane Library、Embase、Web of Science、中国知网、维普、万方等数据库比较肝细胞癌合并微血管侵犯患者手术切除后行TACE与单纯手术无瘤生存率和总体生存率的文献,限定检索时间为1999年1月1日至2019年5月1日。使用Stata 15.0软件和Review Manager 5.3软件进行荟萃分析。结果共纳入8篇符合标准文献,总计1809例患者,其中TACE组815例,单纯手术组994例。荟萃分析显示,TACE组无瘤生存率优于单纯手术组,差异有统计学意义(HR=0.74,95%CZ:O.65~0.85,P<0.05)。TACE组总体生存率优于单纯手术组,差异有统计学意义(HR=0.74,95%CI:0.62-0.89,P<0.05)。亚组分析(4篇)显示术后辅助性TACE可提高肿瘤直径>5 cm患者无瘤生存率(HR=0.72,95%C/:0.58~0.90,P<0.05),但对总体生存率无明显影响。结论肝细胞癌合并微血管侵犯患者术后辅助TACE可提高其总体生存率和无瘤生存率,但是对于肿瘤直径>5 cm的微血管侵犯肝细胞癌患者其疗效可能并不显著,仍需进一步临床研究证实。

Adjuvant transarterial chemoembolization after curative resection for hepatocellular carcinoma with microvascular invasion:a meta-analysis

Objective To study the impact of adjuvant transarterial chemoembolization(TACE)after curative resection for patients with hepatocellular carcinoma(HCC)and microvascular invasion(MVI).Methods PubMed,Cochrane library,Embase,Web of Science,CNKI,VIP,Wanfang were searched for randomized or non-randomized studies which compared recurrence-free survival and overall survival rates with or without postoperative adjuvant TACE after curative resection for patients with HCC and MVI.The limited search time was from January 1st,1999 to May 1st,2019.Statistical analyses were performed with software programs using Stata(version 15.0)and Review Manage(version 5.3).Results Eight studies which included 1809 patients were studied.There were 815 patients who received and 994 patients who did not receive postoperative adjuvant TACE after radical hepatectomy.Postoperative adjuvant TACE significantly improved recurrence-free survival and overall survival rates in patients with HCC and MVI when compared with the patients who required no adjuvant TACE(HR=0.74,95%CI:0.65-0.85,P<0.05;HR=0.74,95%CI:0.62-0.89,P<0.05,respectively).Subgroup analysis demonstrated that patients with tumor diameter>5 cm benefited from postoperative adjuvant TACE only in recurrence-free survival rate(HR=0.72,95%CI:0.58-0.90,P<0.05),but not in overall survival rate.Conclusion Postoperative adjuvant TACE delayed recurrence of microvascular invasion of HCC and improved long-term prognosis,but not for tumors with diameter>5 cm.These results need to be validated in further clinical trials.