Hepatic resection as a safe and effective treatment for hepatocellular carcinoma involving a single large tumor, multiple tumors, or macrovascular invasion.
Hepatic resection as a safe and effective treatment for hepatocellular carcinoma involving a single large tumor, multiple tumors, or macrovascular invasion.
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DOI：
10.1097/md.0000000000000396
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发表时间：
2015-01
期刊：
影响因子：
1.6
通讯作者：
Li LQ
中科院分区：
文献类型：
--
作者：
Zhong JH;Rodríguez AC;Ke Y;Wang YY;Wang L;Li LQ
这项系统评价检查了现有证据是否证明在肝细胞癌 (HCC) 晚期使用肝切除术 (HR) 是合理的，这违反了治疗指南，但在许多医疗中心是目前的做法。官方指南和回顾性研究建议 HR 对于大/多结节性 HCC 或涉及大血管侵犯 (MVI) 的 HCC 患者发挥不同的作用。系统地检索了多个数据库，以查找研究 HR 治疗涉及单个大肿瘤（> 5 cm）或多发肿瘤的 HCC 或治疗涉及 MVI 的 HCC 的安全性和有效性的研究。我们确定了 50 项涉及 14808 名患者的研究，调查了使用 HR 治疗大/多结节性 HCC 的情况，以及 24 项研究，涉及 4389 名患者，调查了 HR 通过 MVI 治疗 HCC 的情况。亚洲研究中任一类型 HCC 患者的院内死亡率中位数 (2.7%) 均显着低于非亚洲研究中的死亡率 (7.3%，P < 0.001)。所有亚洲大/多结节性 HCC 患者的中位总生存期 (OS) 在 1 年（81% vs 65%，P < 0.001）和 5 年（42% vs 32%，P< 0.001）方面均显着高于所有非亚洲患者。 1 年（61% vs 50%，P < 0.001）和 5 年（26% vs 24%，P< 0.001）的中位无病生存率也获得了类似的结果。然而，涉及 MVI 的亚洲和非亚洲 HCC 患者 1 年（50% vs 52%，P = 0.45）和 5 年（18% vs 14%，P = 0.94）的中位 OS 相似。任一类型 HCC 患者的 5 年 OS 均呈上升趋势。 HR 在治疗大型/多结节性 HCC 以及采用 MVI 治疗 HCC 方面相当安全且有效。现有证据主张在官方治疗指南中扩大 HR 的适应症。
This systematic review examined whether the available evidence justifies using hepatic resection (HR) during later stages of hepatocellular carcinoma (HCC), which contravenes treatment guidelines but is current practice at many medical centers. Official guidelines and retrospective studies recommend different roles for HR for patients with large/multinodular HCC or with HCC involving macrovascular invasion (MVI). Several databases were systematically searched for studies examining the safety and efficacy of HR for treating HCC involving a single large tumor (>5 cm) or multiple tumors, or for treating HCC involving MVI. We identified 50 studies involving 14 808 patients that investigated the use of HR to treat large/multinodular HCC, and 24 studies with 4389 patients that investigated HR to treat HCC with MVI. Median in-hospital mortality for patients with either type of HCC was significantly lower in Asian studies (2.7%) than in non-Asian studies (7.3%, P < 0.001). Median overall survival (OS) was significantly higher for all Asian patients with large/multinodular HCC than for all non-Asian patients at both 1 year (81% vs 65%, P < 0.001) and 5 years (42% vs 32%, P < 0.001). Similar results were obtained for median disease-free survival at 1 year (61% vs 50%, P < 0.001) and 5 years (26% vs 24%, P < 0.001). However, median OS was similar for Asian and non-Asian patients with HCC involving MVI at 1 year (50% vs 52%, P = 0.45) and 5 years (18% vs 14%, P = 0.94). There was an upward trend in 5-year OS in patients with either type of HCC. HR is reasonably safe and effective at treating large/multinodular HCC and HCC with MVI. The available evidence argues for expanding the indications for HR in official treatment guidelines.