肝癌根治术后经肝动脉辅助化疗的疗效系统评价

Effect of postoperative TAC after curative resection for hepatocellular carcinoma

目的采用meta分析的方法评价肝癌根治术后经肝动脉途径辅助化疗（TAC）的效果。方法采用计算机结合手工方法检索有关肝癌根治术后TAC的自由随机对照试验（RCTs），合并相似研究方案的RCTs。结果纳入8篇符合要求的RCTs。5个RCTs比较了TAC与非辅助化疗，meta分析结果表明TAC对肝癌术后3年总生存率提高21％（P〈0．05），但有降低3年无瘤生存率6％的风险。异质性分析结果表明肿瘤直径〉5cm增加肿瘤复发风险，但对总生存率影响不大。7个RCTs分单药TAC组和多药联合TAC组，前者显示对肝癌术后预后无益，后者meta分析结果证明能提高1、2年无瘤生存率及1、2、3年总生存时间（P〈0．05）。结论单药TAC对肝癌根治术后预后无显著提高，联合多种化疗药物的TAC能使肝癌术后总生存率及无瘤生存率都得到显著提高，尤其对伴肝硬化型肝癌；肿瘤直径〉5cm时有增加复发的风险，但不是影响肝癌根治术后经肝动脉途径化疗疗效的主要原因。

Objective To evaluate modalities of postoperative transarterial chemotherapy （TAC） after curative resection for hepatocellular carcinoma （HCC） using a randomized meta-analysis. Methods We searched all of RCTs about postoperative TAC for HCC and combined the studies when they investigated a similar modality of adjuvant therapy. Results Eight studies were included. A meta-analysis of 5 randomized controlled trials was carried out. Postoperative TAC increased the 3-year survival rate after operation for 21% （P〈0.05）. But there was the risk of decreasing 3-year tumorfree survival rate for 6 %. The diameter of tumor over 5 cm increased the risk for recurrence and it did not markedly affect the total survival rate. The single-drug TAC was not helpful for prognosis of the tumor. The multi-drug TAC could increase 1- and 2-year tumor-free survival rate and 1-, 2- and 3-year total survival time （P〈0.05）. Conclusion Multi-drug TAC can improve the 3-year survival and tumor-free survival, especially for HCC with cirrhosis. The tumor diameter over 5 cm can increase the risk of HCC recurrence. However, it is not the main reason for reducing the overall survival and tumor-free survival of HCC patients after postoperative TAC.