Adjuvant chemotherapy for patients with primary hepatocellular carcinoma: A meta‐analysis
Adjuvant chemotherapy for patients with primary hepatocellular carcinoma: A meta‐analysis
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DOI：
10.1002/ijc.29203
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发表时间：
2015-03
影响因子：
6.4
通讯作者：
Zhouying Zheng;W. Liang;Dongping Wang;P. Schroder;W. Ju;Lin-wei Wu;Zhengda Zheng;Yushu Shang;Zhiyong Guo;Xiaoshun He
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文献类型：
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作者：
Zhouying Zheng;W. Liang;Dongping Wang;P. Schroder;W. Ju;Lin-wei Wu;Zhengda Zheng;Yushu Shang;Zhiyong Guo;Xiaoshun He
许多研究已经调查了原发性肝细胞癌（HCC）患者辅助化疗的效果。我们进行这项分析是为了评估肝癌患者肝切除术后辅助化疗的疗效。在PubMed/MEDLINE、EMBASE、科克伦和其他数据库中检索合格研究。主要终点为总生存期（OS）和无病生存期（DFS）。使用随机效应模型计算汇总比值比（OR），以总结结果。在对13项随机对照试验（RCT）和35项观察性研究（共4747例患者）进行的Meta分析中，肝切除术联合辅助化疗在1年DFS方面优于单纯肝切除术（OR = 1.86，1.38-2.51，p < 0.001），3年DFS（OR = 2.37，1.73-3.24，p < 0.001）和5年DFS（OR = 1.99，1.55-2.55，p < 0.001）以及1年OS（OR = 2.16，95%置信区间1.75-2.68，p < 0.001），3年OS（OR = 1.77，1.48-2.13，p < 0.001）和5年OS（OR = 1.92，1.44-2.56，p < 0.001）。亚组和敏感性分析显示，只有辅助TACE具有显著的生存获益。对门静脉癌栓（PVTT）患者的Meta分析显示，治疗组的预后优于对照组，而其他因素与复发风险无关。目前的研究表明，辅助化疗可以改善HCC患者的预后。辅助TACE的获益已得到证实，而其他辅助化疗方式的效果仍不确定。辅助化疗可能更适用于某些患者人群，例如PVTT患者，但进一步研究确定这些患者因素对于未来为个体患者定制辅助治疗非常重要。
Numerous studies have investigated the effects of adjuvant chemotherapy for primary hepatocellular carcinoma (HCC) patients. We conducted this analysis to evaluate the efficacy of adjuvant chemotherapy in HCC patients after hepatectomy. PubMed/MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies. The major endpoints were overall survival (OS) and disease‐free survival (DFS). The pooled odds ratio (OR) was calculated using a random‐effects model to summarize the results. In the meta‐analysis of 13 randomized control trials (RCTs) and 35 observational studies with 4747 patients, hepatectomy plus adjuvant chemotherapy showed superiority over hepatectomy alone in 1‐year DFS (OR = 1.86, 1.38–2.51, p < 0.001), 3‐year DFS (OR = 2.37, 1.73–3.24, p < 0.001) and 5‐year DFS (OR = 1.99, 1.55–2.55, p < 0.001), as well as 1‐year OS (OR = 2.16, 95% confidence interval 1.75–2.68, p < 0.001), 3‐year OS (OR = 1.77, 1.48–2.13, p < 0.001) and 5‐year OS (OR = 1.92, 1.44–2.56, p < 0.001). Subgroup and sensitivity analysis revealed that only adjuvant TACE had significant survival benefits. The meta‐analysis of studies involving patients with portal vein tumor thrombus (PVTT), but not other factors related to recurrence risk, revealed favorable outcomes of the Treatment arm over the Control arm. The present study shows that adjuvant chemotherapy can improve outcomes for HCC patients. The benefits of adjuvant TACE have been confirmed whereas the effects of other adjuvant chemotherapy modalities remain uncertain. Adjuvant chemotherapy is likely to be more applicable to certain patient populations for instance those with PVTT, but further research in identifying these patient factors is of importance for tailoring adjuvant therapies to individual patients in the future.