解剖性肝切除和非解剖性肝切除对中国肝癌分期Ⅰa期患者预后影响的荟萃分析

Effect of anatomic resection and nonanatomic resection on prognosis of patients with CNLC stageⅠa hepatocellular carcinoma:a systematic review and meta-analysis

目的选择中国肝癌分期Ⅰa期肝细胞癌患者,评价解剖性肝切除和非解剖性肝切除对预后的影响。方法计算机检索PubMed、Cochrane Library、Embase数据库中2000年1月至2021年3月关于中国肝癌分期Ⅰa期肝细胞癌解剖性肝切除与非解剖性切除的文章,对患者特征、肿瘤特征、手术特征、术后病理特征和远期预后进行系统评价。结果共纳入9项病例对照研究,2761例患者,其中解剖性肝切除组1727例,非解剖性肝切除组1034例。与非解剖性肝切除组比较,解剖性肝切除组基线特征为肝硬化占比更少、肝脏储备功能更好、Child-Pugh A级占比更多;另外,解剖性肝切除组的肿瘤长径更大、微血管侵犯率更高、手术时间更长、术中失血量更多。长期预后方面,与非解剖性肝切除组相比,解剖性肝切除组获得了更好的术后5年无瘤生存率[比值比(OR)=1.54,95%CI:1.30~1.82,P<0.001]和5年总体生存[OR=1.27,95%CI:1.04~1.55,P=0.018]。结论解剖性肝切除对于降低中国肝癌分期Ⅰa期肝细胞癌患者远期复发和改善长期生存显著优于非解剖性肝切除。

Objective To evaluate the effect of anatomic resection(AR)and nonanatomic resection(NAR)on the prognosis of hepatocellular carcinoma(HCC)patients of China Liver Cancer Staging(CNLC)Ⅰa.Methods PubMed,Embase and Cochrane Library databases were searched for articles on AR and NAR of CNLCⅠa stage HCC from January 2000 to March 2021.A meta-analysis was performed on patient characteristics,tumor characteristics,surgical procedures,postoperative pathological characteristics and long-term prognosis.Results Of 9 case-control studies were included in this study,there were 2761 patients,with 1727 cases in the AR group and 1034 cases in the NAR group.When compared with the NAR group,the AR group had lower proportion of liver cirrhosis,lower ICG R15 value,higher proportion of Child-Pugh A grade,larger tumor diameter,higher proportion of microvascular invasion,longer operation time and higher intraoperative blood loss.The AR group had a better postoperative 5-year disease-free survival rate[OR=1.54,95%CI:1.30-1.82,P<0.001]and a higher postoperative 5-year overall survival rate[OR=1.27,95%CI:1.04-1.55,P=0.018].Conclusion AR is significantly better than NAR for preventing long-term recurrence and improving long-term survival in patients with CNLCⅠa stage HCC.