挽救性肝移植与再次肝切除治疗术后复发性肝癌疗效对比的Meta分析

Clinical efficacy of salvage liver transplantation versus repeat hepatectomy for recurrent hepatocellular carcinoma after hepatectomy:a Meta-analysis

背景与目的:挽救性肝移植(SLT)与再次肝切除术(RH)哪种治疗方式更有利于术后复发性肝癌患者,目前尚无一致结论,亦无大样本量的多中心研究予以证实。本研究通过Meta分析方法评价SLT与RH治疗术后复发性肝癌的临床疗效,以期为术后复发性肝癌的治疗选择提供参考。方法:检索多个国内外数据库,检索时间为建库起至2019年8月,收集比较SLT和RH治疗术后复发性肝癌临床疗效的临床研究。由2名研究者独立筛选文献和提取数据,并进行文献质量评价后,以总体生存率以及无瘤生存率为主要结局指标进行Meta分析。结果:最终纳入符合标准的6篇回顾性队列研究,共650例患者,其中SLT组134例,RH组516例。Meta分析结果显示,SLT组与RH组术后1、3年总体生存率差异无统计学意义(OR=1.70,95%CI=0.82~3.53,P=0.15;OR=1.10,95%CI=0.70~1.72,P=0.67),但SLT组5年总体生存率明显优于RH组(OR=1.56,95%CI=1.03~2.37,P=0.04)。SLT组1、3、5年无瘤生存率均明显优于RH组(OR=5.91,95%CI=3.16~11.05,P<0.00001;OR=3.98,95%CI=2.57~6.16,P<0.00001;OR=4.37,95%CI=2.03~9.44,P=0.0002)。SLT组患者术后并发症发生率高于RH组(OR=4.67,95%CI=2.72~8.01,P<0.00001)。两组围手术期病死率差异无统计学意义(OR=3.92,95%CI=0.41~37.80,P=0.24)。SLT组患者术中出血量高于RH组、院时间长于RH组(均P<0.05)。结论:SLT治疗术后复发性肝癌安全、有效;与RH比较,SLT可显著改善患者术后无瘤生存率,获得较好的远期预后。但供肝来源的短缺,使RH仍是复发性肝癌的重要治疗手段。

Background and Aims:Salvage liver transplantation(SLT)versus repeat hepatectomy(RH),which one is more beneficial to patients with recurrent hepatocellular carcinoma after primary resection is still inconclusive,and has no verification from the large multicenter clinical trials as well at present time.This study was aimed to evaluate the clinical efficacy of LT and RH for recurrent hepatocellular carcinoma after hepatectomy through a Meta-analysis,so as to provide reference for treatment selection of this condition.Methods:The clinical studies comparing efficacy of SLT versus RH in treatment of recurrent hepatocellular carcinoma after hepatectomy were collected by searching several national and international databases in the time period from the inception of the databases to August 2019.After literature screening,data extraction and quality assessment conducted by two independent reviewer,Meta-analysis was performed using the overall survival rate and disease-free survival rate as the main outcome variables.Results:Six retrospective cohort studies meeting the inclusion criteria were finally included,involving 650 patients with 134 case in SLT group and 516 case in RH group.Results of Meta-analysis showed that the 1-and 3-year overall survival rates had no statistically significant difference between SLT group and RH group(OR=1.70,95%CI=0.82–3.53,P=0.15;OR=1.10,95%CI=0.70–1.72,P=0.67),but the 5-year overall survival rate in SLT group was significantly superior to that in RH group(OR=1.56,95%CI=1.03–2.37,P=0.04);the 1-,3-and 5-year disease-free survival rates in SLT group were all significantly to those in RH group(OR=5.91,95%CI=3.16–11.05,P<0.00001;OR=3.98,95%CI=2.57–6.16,P<0.00001;OR=4.37,95%CI=2.03–9.44,P=0.0002).The incidence of postoperative complications in SLT group was significantly higher than that in the RH group(OR=4.67,95%CI=2.72–8.01,P<0.00001).There was no significant difference in perioperative mortality between the two groups(OR=3.92,95%CI=0.41–37.80,P=0.24).The intraoperative blood loss was significantly higher and the length of hospital stay were significantly longer SLT group than those in the RH group(both P<0.05).Conclusion:SLT is a safe and effective approach for postoperative recurrent hepatocellular carcinoma.Compared to RH,SLT can significantly improve postoperative disease-free survival rate and obtain a better long-term prognosis.However,considering the shortage of liver donor,RH is still an important treatment for postoperative recurrent hepatocellular carcinoma.