Downstaging hepatocellular carcinoma: A systematic review and pooled analysis
Downstaging hepatocellular carcinoma: A systematic review and pooled analysis
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DOI：
10.1002/lt.24169
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发表时间：
2015-09-01
影响因子：
4.6
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
--
作者：
Parikh, Neehar D.;Waljee, Akbar K.;Singal, Amit G.
降期可以促进不符合米兰标准的肝细胞癌 (HCC) 患者的肝移植 (LT)；然而，最佳方案和降期结果的定义不明确。我们的目的是描述接受降期的患者中成功降期至米兰标准的比率以及 LT 后复发和生存率。我们使用 1996 年 1 月至 2015 年 3 月的 MEDLINE 和 Embase 数据库进行了系统性文献综述，并检索了 2010 年至 2014 年的全国会议摘要。计算了降期成功率（定义为米兰境内肿瘤负荷减少）和 LT 后复发率（95% 置信区间 (CI)）。根据治疗方式、研究设计和患者特征进行预先指定的亚组分析。评估降期成功的 13 项研究（n = 950 名患者）的合并成功率为 0.48（95% CI，0.39-0.58%）。在亚组分析中，经动脉化疗栓塞（TACE）与经动脉放射栓塞（TARE；P = 0.51）比较，没有显着差异，但前瞻性研究与回顾性研究相比，成功率更高（0.68 与 0.44；P < 0.001）。评估 LT 后 HCC 复发的 12 项研究（n = 320 名患者）的汇总复发率为 0.16（95% CI，0.11-0.23）。 TACE 和 TARE 的复发率无显着差异（P = 0.33）。由于生存数据报告的异质性，无法汇总 LT 后生存情况。目前的数据在基线肿瘤负荷、等待时间、降期方案和治疗反应评估方面存在异质性。还存在显着的局限性，包括纳入标准、降期方案和结果评估标准的报告不一致。总之，将 HCC 降期至米兰标准的成功率超过 40%；然而，移植后 HCC 复发率高达 16%。应系统研究和优化 HCC 降期方案，以尽量减少 LT 后 HCC 复发的风险。肝脏移植 21:1142-1152, 2015。(c) 2015 AASLD。
Downstaging can facilitate liver transplantation (LT) for patients outside of Milan criteria with hepatocellular carcinoma (HCC); however, the optimal protocol and downstaging outcomes are poorly defined. We aimed to characterize rates of successful downstaging to within Milan criteria and post-LT recurrence and survival among patients who underwent downstaging. We performed a systematic literature review using the MEDLINE and Embase databases from January 1996 through March 2015 and a search of national meeting abstracts from 2010 to 2014. Rates of downstaging success (defined as a decrease of tumor burden to within Milan) and post-LT recurrence with 95% confidence intervals (CIs) were calculated. Prespecified subgroup analyses were conducted by treatment modality, study design, and patient characteristics. Thirteen studies (n = 950 patients) evaluating downstaging success had a pooled success rate of 0.48 (95% CI, 0.39-0.58%). In subgroup analyses, there was no significant difference comparing transarterial chemoembolization (TACE) versus transarterial radioembolization (TARE; P = 0.51), but there were higher success rates in prospective versus retrospective studies (0.68 versus 0.44; P < 0.001). The 12 studies (n = 320 patients) evaluating post-LT HCC recurrence had a pooled recurrence rate of 0.16 (95% CI, 0.11-0.23). There was no significant difference in recurrence rates between TACE and TARE (P = 0.33). Post-LT survival could not be aggregated because of heterogeneity in survival data reporting. Current data have heterogeneity in baseline tumor burden, waiting time, downstaging protocols, and treatment response assessments. There are also notable limitations including inconsistent reporting of inclusion criteria, downstaging protocols, and outcome assessment criteria. In conclusion, the success rate of downstaging HCC to within Milan criteria exceeds 40%; however, posttransplant HCC recurrence rates are high at 16%. Downstaging protocols for HCC should be systematically studied and optimized to minimize the risk of post-LT HCC recurrence. Liver Transpl 21:1142-1152, 2015. (c) 2015 AASLD.