肝门部胆管癌患者行肝移植和根治切除术后生存结果的对比分析

Survival outcome comparative analysis of Liver transplantation and radical resection surgery for Klatskin tumor

目的 通过对已发表文献资料分析比较肝门部胆管癌（KT）患者行肝移植（LT）和根治切除（RR）术的生存结果.方法 应用Medline检索1996年1月至2014年12月间KT治疗的相关英文文献,选择包括LT和RR的研究,提取数据并采用Review Manager 5.0软件进行荟萃分析.结果 11篇文献共676例KT患者入选,进行荟萃分析后发现患者行LT和RR两组的生存率具有可比性（1年RR 1.00,95％ CI0.82 ～ 1.23,P=0.97;3年RR 1.15,95％ CI0.75～ 1.77,P=0.51;5年RR 1.37,95％ CI0.74 ～2.53,P=0.32）.LT组1、3、5年生存率分别为89.2％、66.6％、34.4％,RR组1、3、5年生存率分别为89.3％、64.4％、29.7％,两组短期和长期总体生存率差异无统计学意义,但是总生存趋势显示LT组长期生存趋势更好,比RR组有潜在的更长生存时间.结论 LT与RR两组KT患者的术后生存率差异无统计学意义,但LT组术后长期生存趋势更好,复发率更低,尤其对于不可切除或肝功能差而不能耐受手术的KT患者,LT具有治疗优势.

Objective To compare the survival results of liver transplantation with radical resection for klatskin tumor based on the published literatures.Methods We retrieved Medline for articles on treatment of klatskin tumor published from January 1996 to December 2014,and choose the literatures including liver transplantation and radical resection.Review Manager 5.0 software was used to perform the Meta-analysis of the extracted data.Results After performing meta-analysis of 11 studies including 676 patients,we found comparable patient survival rate between liver transplantation group and radical resection group （1-year RR：1.00,95% CI：0.82-1.23,P =0.97;3-year RR：1.15,95% CI：0.75-1.77,P =0.51,5-year RR：1.37,95 % CI：0.74-2.53,P =0.32,respectively）.No statistical significance of overall survival rate were shown between this 2 groups whether in short-term or long-time,but the total survival trends show the long-time survival of LT group is better than that of RR group which has the potential longer survival time.Conclusions Liver transplantation was equivalent to radical resection for klatskin tumor treatment in terms of patient survival,with potential higher long-term patient survival rate and lower recurrence.especially for the patients with unrespectable KT or insufficient liver function,LT is superior for clinical outcome.