Thrombocytopenia for prediction of hepatocellular carcinoma recurrence: Systematic review and meta-analysis
Thrombocytopenia for prediction of hepatocellular carcinoma recurrence: Systematic review and meta-analysis
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DOI：
10.3748/wjg.v21.i25.7895
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发表时间：
2015-07-07
影响因子：
4.3
通讯作者：
Liu, Chang
中科院分区：
文献类型：
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作者：
Pang, Qing;Qu, Kai;Liu, Chang
目的：探讨血小板减少症与肝细胞癌（HCC）治疗后复发的关系。方法：我们检索PubMed、EMBASE和Web of Science数据库以获得符合条件的研究。通过随机效应模型合并风险比（HR）值和95%置信区间（CI）。随后，我们估计异质性，进行敏感性分析，确定发表偏倚，并进行亚组和荟萃回归分析。研究质量通过使用牛津循证医学中心的工具进行评估。结果：我们通过检索（2000-2014年期间发表）确定了18个合格的研究。在招募的4163例HCC患者中，2746例（66.0%）复发。总体而言，我们的荟萃分析表明，治疗前血小板计数（PLT）低显著增加术后复发的概率（HR = 1.53，95%CI：1.29-1.81）。PLT对肝内远处复发的预测也有价值（HR = 1.49，95% CI：1.25-1.77）。亚组和荟萃回归分析确定了各种治疗方式的高度异质性的来源。当删除单个研究时，合并的HR值未显示出明显变化，但除此之外，使用了相反效应模型。结论：治疗前血小板减少可能是HCC患者术后复发的一个廉价和有用的预测因子。
AIM: To investigate the association between thrombocytopenia and relapse after treatment for hepatocellular carcinoma (HCC).METHODS: We searched the PubMed, EMBASE, and Web of Science databases to obtain eligible studies. The hazard ratios (HRs) values and 95% confidence intervals (CIs) were pooled by random effects model. Subsequently, we estimated the heterogeneity, performed a sensitivity analysis, determined the publication bias, and performed subgroup and meta-regression analyses. Study quality was assessed by using the Oxford Center for Evidence Based Medicine tool.RESULTS: We identified 18 eligible studies by retrieval (published during 2000-2014). Out of the 4163 patients with HCC who were recruited, 2746 (66.0%) experienced recurrence. In general, our meta-analysis suggested that low platelet count (PLT) before therapy significantly increased the probability of postoperative recurrence (HR = 1.53, 95% CI: 1.29-1.81). PLT was also valuable in the prediction of intrahepatic distant recurrence (HR = 1.49, 95% CI: 1.25-1.77). Subgroup and meta-regression analyses identified various therapeutic modalities as the source of a high degree of heterogeneity. The pooled HR values showed no obvious change when a single study was removed, but otherwise, an opposite-effects model was used. In addition, no significant publication bias was detected.CONCLUSION: Thrombocytopenia before treatment might be an inexpensive and useful predictor of postoperative recurrence in patients with HCC.