挽救性肝移植与原位肝移植对肝癌患者临床疗效的Meta分析

To compare salvage liver transplantation with othotopic liver transplantation for patients with hepatocellular carcinoma:a Meta-analysis

目的比较挽救性肝移植(SLT)与原位肝移植(OLT)对肝癌患者的临床疗效。方法系统检索PubMed、Embase、Cochrane Library、万方、NCKI、VIP和SinoMed,检索时限为建库起至2017年10月。筛选文献及提取数据后,采用Stata 14软件对有效数据进行Meta分析。结果分析共纳入23项研究,累积4161例患者。其中SLT组579例,OLT组3582例。与OLT比较,SLT组患者手术时间长(SMD=0.56,95%CI:0.29~0.83),术中出血量多(SMD=1.56,95%CI:0.63~2.49),术后出血发生率高(OR=1.84,95%CI:1.08~3.14),两组患者差异均有统计学意义(均P<0.05)。SLT组患者累积生存时间(HR=1.29;95%CI:1.11~1.49)与无病生存率(HR=1.88;95%CI:1.26~2.81)较OLT低(均P<0.05)。两组患者胆道并发症(OR=1.25;95%CI:0.79~1.98)、血管并发症(OR=1.41;95%CI:0.69~2.89)、脓毒症(OR=1.10;95%CI:0.60~1.99)、急性排斥反应(OR=1.25;95%CI:0.69~2.28)、围手术期病死率(OR=1.60;95%CI:0.94~2.70)差异均无统计学意义(均P>0.05)。结论与SLT比较,OLT是治疗可移植肝癌的更好方式。但供体来源的限制以及SLT的可行性及安全性,使SLT成为肝切除术后复发肝癌患者治疗的一种较好选择。

ObjectiveTo compare salvage liver transplantation (SLT) with othotopic liver transplantation (OLT) in treatment of hepatocellular carcinoma.MethodsA systematic literature search of PubMed, Embase, Cochrane Library, CBM, CNKI and Wanfang Med Online was performed from their dates of establishment to October 2017. The results were screened, data extracted and then analyzed with Stata 14. Results23 studies with 4 161 patients were selected, including 579 patients in the SLT group and 3 582 patients in the OLT group. Compared with OLT, SLT was associated with a longer operative time (SMD=0.56, 95%CI: 0.29~0.83), higher intraoperative blood loss (SMD=1.56, 95%CI: 0.63~2.49), an increased risk of postoperative bleeding (OR=1.84, 95%CI: 1.08~3.14), a poorer overal survival rate (HR=1.29;95%CI: 1.11~1.49) and disease free survival rate (HR=1.88;95%CI: 1.26~2.81). The differences were all significant (all P<0.05). The biliary complications (OR=1.25;95%CI: 0.79~1.98), vascular complications (OR=1.41;95%CI: 0.69~2.89), sepsis (OR=1.10;95%CI: 0.60~1.99), acute rejection (OR=1.25;95%CI: 0.69~2.28) and perioperative mortality (OR=1.60;95%CI: 0.94~2.70) rates were not significantly different (all P>0.05).ConclusionsOLT is a better treatment strategy for patients with transplantable hepatocellular carcinoma (HCC) compared with SLT. However, severe organ limitation, and feasibility and safety of surgery make SLT a better option for patients with HCC recurrence after liver resection.