补救性肝移植临床疗效的系统评价

Clinical effect of salvage liver transplantation in the treatment of recurrent hepatocellular carcinoma after hepatectomy: a systematic review

目的评价补救性肝移植(SLT)治疗肝癌的疗效。方法计算机检索Pub Med、EMbase、Cochrane数据库、中国生物医学文献数据库、中国学术期刊(网络版)、中国学术期刊数据库和中文科技期刊全文数据库。无语种限制,检索日期截至2016年8月31日。收集公开发表的关于SLT与一期肝移植(PLT)治疗肝癌的病例对照研究,对纳入的文献进行资料提取和质量评价,采用Revman 5.3软件进行统计分析。结果纳入17项研究共9 335例患者,SLT和PLT术后1年生存率及1年无瘤生存率差异无统计学意义(RR=0.93,95%CI:0.80~1.08,P=0.36;RR=0.94,95%CI:0.81~1.08,P=0.40),但3、5年生存率及3、5年无瘤生存率差异有统计学意义(RR=0.88,95%CI:0.77~1.00,P=0.04;RR=0.86,95%CI:0.76~0.98,P=0.02;RR=0.83,95%CI:0.73~0.94,P=0.005;RR=0.77,95%CI:0.67~0.88,P=0.001),PLT疗效优于SLT。结论 PLT术后远期疗效优于SLT。

Objective To evaluate the clinical efficacy of salvage liver transplantation（SLT） for hepatocellular carcinoma. Methods Information up to August 31 th 2016 was retrieved from Cochrane library,Pubmed,EMbase,CBM,CNKI,CSPD and VIP without linguistic constraints. Collected publications were all about case-control study of SLT or primary liver transplantation for hepatocellular carcinoma. All the included articles were performed with data extraction and quality assessment and then analyzed with Rev Man 5. 3. Results A total of 17 articles including 9 335 patients were enrolled.There was no statistic difference between SLT and PLT on 1-year survival rate,1-year disease-free survival rate（RR = 0. 93,95% CI： 0. 80-1. 08,P = 0. 36; RR = 0. 94,95% CI： 0. 81-1. 08,P = 0. 40）.However,3-year survival rate and 5-year disease-free survival rate of PLT were higher than SLT（RR =0. 88,95% CI： 0. 77-1. 00,P = 0. 04; RR = 0. 86,95% CI： 0. 76-0. 98,P = 0. 02; RR = 0. 83,95% CI：0. 73-0. 94,P = 0. 005; RR = 0. 77,95% CI： 0. 67-0. 88,P = 0. 001）. Conclusion Long-term efficacy of PLT was better than SLT.