Vitamin Analogues in Chemoprevention of Hepatocellular Carcinoma After Resection or Ablation-A Systematic Review and Meta-analysis
Vitamin Analogues in Chemoprevention of Hepatocellular Carcinoma After Resection or Ablation-A Systematic Review and Meta-analysis
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DOI：
10.1016/s1015-9584(10)60021-8
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发表时间：
2010-07-01
影响因子：
3.5
通讯作者：
Cheng, Shu-Qun
中科院分区：
文献类型：
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作者：
Chu, Kai-Jian;Lai, Eric C. H.;Cheng, Shu-Qun
目的：虽然肝切除术或局部消融治疗可能为肝细胞癌（HCC）提供潜在的治愈治疗，但超过一半的患者在治疗后5年内复发HCC。因此，确定任何可以减少或延迟复发发生率的治疗方法将改善治疗结果。然而，目前还没有化学预防药物被批准用于HCC。方法：使用MEDLINE数据库、Embase、Cancerlit（国家癌症研究所）和CBM（中国生物医学数据库）检索1990年至2009年的相关文献，检索关键词为“肝细胞癌”、“维生素类似物”和“化学预防”。通过人工检索关键文章的参考文献，确定了其他论文。采用固定效应模型进行meta分析。结果：口服无环类维甲酸（维生素A类似物）和美那曲酮（维生素K-2类似物）作为肝癌肝切除术或局部消融治疗后的化学预防药物已被测试。分别有1项和4项随机对照试验（rct）评估聚戊酸和美那屈酮的疗效。所有的研究都在日本进行。一项RCT显示聚戊酸在降低肝切除术或经皮乙醇注射后HCC复发发生率方面的预防作用，这种作用持续到随机分组后199周（或类视黄醇给药完成后151周）。四项随机对照试验评估了美那曲酮对肝切除或局部消融治疗后肝癌复发的预防效果。三项研究的结果以及所有四项研究的荟萃分析显示，无肿瘤复发生存期明显改善。对总体生存的有益影响不太确定。结论：有证据表明肝部分切除术或局部消融治疗后的化学预防治疗有利于延长无病生存期，但对总生存期的影响较少。为了证实维生素A或K类似物在化学预防HCC中的有益作用，现在需要进一步和更大的随机试验。[J]中华外科杂志2010；33 (3): 120 - 6]
OBJECTIVE: While hepatic resection or local ablative therapy may provide a potentially curative treatment for hepatocellular carcinoma (HCC), more than half of these patients develop recurrent HCC within 5 years after treatment. Thus identification of any therapy which can decrease or delay the incidence of recurrence will improve the results of treatment. However, no chemopreventive agent has been approved for HCC.METHODS: A MEDLINE database, Embase, Cancerlit (National Cancer Institute), and CBM (Chinese Biomedical Database) search from 1990 to 2009 was performed to identify relevant articles using the keywords "hepatocellular carcinoma," "vitamin analogue," and "chemoprevention." Additional papers were identified by a manual search of the references from the key articles. The fixed effect model was used for a meta-analysis.RESULTS: Oral administration of acyclic retinoids (vitamin A analogue), and menatetrenone (vitamin K-2 analogue) have been tested as chemopreventive agents after hepatic resection or local ablative therapy for HCC. There were one and four randomised, controlled trials (RCTs) which evaluated the efficacy of polyprenoic acid and menatetrenone, respectively. All studies were conducted in Japan. One RCT showed the preventive effect of polyprenoic acid in lowering the incidence of HCC recurrence after hepatic resection or percutaneous ethanol injection, and this effect lasted up to 199 weeks after randomization (or 151 weeks after completion of retinoid administration). Four RCTs evaluated the preventive efficacy of menatetrenone on HCC recurrence after hepatic resection or local ablative therapy. The results of three studies, as well as the meta-analysis of all four studies, showed significantly better tumour recurrence-free survival. The beneficial effect on the overall survival was less definite.CONCLUSION: There is evidence to suggest that chemopreventive therapy after partial hepatectomy or local ablative therapy is beneficial in prolonging disease-free survival, but the evidence is less for an effect on the overall survival. To confirm the beneficial role of vitamin A or K analogues in the chemoprevention of HCC further and larger randomised trials are now required. [Asian J Surg 2010;33(3):120-6]