T2期胆囊癌最佳肝切除范围的Meta分析

Meta-analysis of the optimal resection scope of hepatectomy for T2 gallbladder carcinoma

背景与目的:胆囊癌(GBC)是胆道系统恶性肿瘤中最常见的肿瘤,占全球胆道恶性肿瘤的80%~95%,预后较差,5年总生存(OS)率仅为10%~25%。目前,根治性切除是唯一可能治愈GBC的方法,但对于T2期GBC的肝切除范围各指南推荐不一。因此,本研究对T2期GBC最佳肝切除范围进行系统评价。方法:计算机检索PubMed、Embase、Web of science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库、维普数据库,根据纳入和排除标准选取文献,使用NOS评分评估纳入文献的质量,采用RevMan 5.4版软件分析评估各组患者1、3、5年的生存差异。结果:最终纳入8篇文献,8篇文献均纳入T2期GBC,其中2篇文献纳入T2a期和T2b期GBC。Meta分析结果显示,T2期GBC行距胆囊床2 cm以上的肝组织切除术及肝IVb+V段切除术,R0与R1切除的1、3、5年OS率差异均无统计学意义(OR=0.70,95%CI=0.45~1.09,P=0.12;OR=1.10,95%CI=0.79~1.53,P=0.58;OR=1.18,95%CI=0.89~1.56,P=0.25);R0切除的1、5年OS率差异均无统计学意义(OR=0.84,95%CI=0.49~1.44,P=0.53;OR=0.89,95%CI=0.64~1.25,P=0.51),而3年OS率差异有统计学意义(OR=1.46,95%CI=1.03~2.07,P=0.03);T2a期和T2b期GBC行距胆囊床2 cm以上的肝组织切除术及肝IVb+V段切除术,R0切除的术后5年OS率差异均无统计学意义(OR=0.55,95%CI=0.18~1.64,P=0.28;OR=0.99,95%CI=0.49~2.00,P=0.97)。结论:T2期GBC可行距胆囊床2 cm以上的肝组织切除术或肝IVb+V段切除术,以达到R0切除为目的。

Background and Aims:Gallbladder carcinoma(GBC)is the most common malignant tumor of the biliary system,accounting for 80%-95%of biliary malignancies worldwide,and has a poor prognosis with a 5-year overall survival(OS)rate of only 10%-25%.At present,radical resection is the only possible way to cure GBC,but the recommended scopes of hepatic resection for T2 GBC are different in different guidelines.Therefore,this study was conducted to systematically evaluate the optimal scope of hepatectomy for T2 GBC.Methods:Computer retrieval was performed in PubMed,Embase,Web of science,Cochrane Library,China Biology Medicine disc(CBMdisc),China National Knowledge Infrastructure(CNKI),Wanfang Database and VIP Database according to the inclusion and exclusion criteria,and the quality of eligible literature was assessed by the Newcastle-Ottawa Scale.RevMan version 5.4 software was used to analysis the difference of 1-,3-,5-year OS rate of patients of each group.Results:Finally,8 papers were selected,all included stage T2 GBC,and two of which included stage T2a and T2b GBC.Meta-analysis results showed that there was no difference in R0 and R1 section of stage T2 GBC between the wedge liver resection with at least a 2-cm margin from the gallbladder bed and liver segmentⅣb+V resection in 1-,3-,and 5-year OS rate(OR=0.70,95%CI=0.45-1.09,P=0.12;OR=1.10,95%CI=0.79-1.53,P=0.58;OR=1.18,95%CI=0.89-1.56,P=0.25).There was no significant difference in 1-and 5-year OS rates for R0 resection(OR=0.84,95%CI=0.49-1.44,P=0.53;OR=0.89,95%CI=0.64-1.25,P=0.51),while the 3-year OS rate was significantly different(OR=1.46,95%CI=1.03-2.07,P=0.03).There was no significant difference in the 5-year OS rate of R0 section of stage T2a and stage T2b GBC with liver tissue resection with at least a 2-cm margin from the gallbladder bed and the liver segmentⅣb+V resection(OR=0.55,95%CI=0.18-1.64,P=0.28;OR=0.99,95%CI=0.49-2.00,P=0.97).Conclusions:Both liver tissue resection with at least a 2-cm margin from the gallbladder bed and the liver segmentⅣb+V resection can be performed to achieve R0 resection for stage T2 GBC.