肝细胞癌肿瘤体积加倍时间：系统评价和荟萃分析

StephenW

Hepatocellular carcinoma tumour volume doubling time: a systematic review and meta-analysis

    http://orcid.org/0000-0002-4316-414XPiyush Nathani1, Purva Gopal2, Nicole Rich1, Adam Yopp3, Takeshi Yokoo4, Binu John5, Jorge Marrero1, http://orcid.org/0000-0002-5874-9933Neehar Parikh6, Amit G Singal1

Author affiliations

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
    Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
    Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
    Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
    Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VAMC, Richmond, Virginia, USA
    Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

    Correspondence to Dr Amit G Singal, Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA; [email protected]

Abstract

Background Tumour growth patterns have important implications for surveillance intervals, prognostication and treatment decisions but have not been well described for hepatocellular carcinoma (HCC). The aim of our study was to characterise HCC doubling time and identify correlates for indolent and rapid growth patterns.

Methods We performed a systematic literature review of Medline and EMBASE databases from inception to December 2019 and national meeting abstracts from 2010 to 2018. We identified studies reporting HCC tumour growth or tumour volume doubling time (TVDT), without intervening treatment, and abstracted data to calculate TVDT and correlates of growth patterns (rapid defined as TVDT <3 months and indolent as TVDT >9 months). Pooled TVDT was calculated using a random-effects model.

Results We identified 20 studies, including 1374 HCC lesions in 1334 patients. The pooled TVDT was 4.6 months (95% CI 3.9 to 5.3 months I2=94%), with 35% classified as rapid, 27.4% intermediate and 37.6% indolent growth. In subgroup analysis, studies from Asia reported shorter TVDT than studies elsewhere (4.1 vs 5.8 months). The most consistent correlates of rapid tumour growth included hepatitis B aetiology, smaller tumour size (continuous), alpha fetoprotein doubling time and poor tumour differentiation. Studies were limited by small sample sizes, measurement bias and selection bias.

Conclusion TVDT of HCC is approximately 4–5 months; however, there is heterogeneity in tumour growth patterns, including more aggressive patterns in Asian hepatitis B-predominant populations. Identifying correlates of tumour growth patterns is important to better individualise HCC prognostication and treatment decisions.
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http://dx.doi.org/10.1136/gutjnl-2020-321040

StephenW

肝细胞癌肿瘤体积加倍时间：系统评价和荟萃分析

    http://orcid.org/0000-0002-4316-414XPiyush Nathani1，Purva Gopal2，Nicole Rich1，Adam Yopp3，Takeshi Yokoo4，Binu John5，Jorge Marrero1，http：//orcid.org/0000-0002-5874-9933Neehar Parikh6，Amit G Singal1

作者单位

    美国德克萨斯州达拉斯的德克萨斯大学西南医学中心内科
    美国德克萨斯州达拉斯的德克萨斯大学西南医学中心病理学系
    美国德克萨斯州达拉斯的德克萨斯大学西南医学中心外科
    美国德克萨斯州达拉斯的德克萨斯大学西南医学中心放射科
    弗吉尼亚联邦大学胃肠病学，肝病学和营养学以及美国弗吉尼亚州里士满市的McGuire VAMC
    密歇根大学内科，美国密歇根州安阿伯

    通讯作者：美国德克萨斯州达拉斯市西南大学内科医学科博士Amit G Singal； [email protected]

抽象

背景肿瘤的生长方式对监测间隔，预后和治疗决策具有重要意义，但对于肝细胞癌（HCC）尚无很好的描述。我们研究的目的是表征HCC倍增时间，并确定惰性和快速生长方式的相关性。

方法我们从开始到2019年12月对Medline和EMBASE数据库进行了系统的文献综述，并于2010年至2018年对全国会议摘要进行了研究。我们确定了报告HCC肿瘤生长或肿瘤体积加倍时间（TVDT）且未进行干预的研究，并将数据提取至计算TVDT并与增长模式相关（快速定义为TVDT <3个月，缓慢定义为TVDT> 9个月）。使用随机效应模型计算合并的TVDT。

结果我们鉴定了20项研究，包括1334例患者的1374例HCC病变。合并的TVDT为4.6个月（95％CI 3.9到5.3个月I2 = 94％），其中35％被归为快速，27.4％为中度和37.6％为惰性增长。在亚组分析中，亚洲的研究报告的TVDT比其他地方的研究短（4.1个月与5.8个月）。肿瘤快速生长的最一致的相关因素包括乙型肝炎病因，较小的肿瘤大小（连续），甲胎蛋白的倍增时间和较差的肿瘤分化。研究受到样本量小，测量偏差和选择偏差的限制。

结论肝癌的TVDT约为4-5个月。但是，肿瘤的生长方式存在异质性，包括以亚洲乙型肝炎为主的人群更具侵略性。鉴定肿瘤生长方式的相关性对于更好地个体化HCC的预后和治疗决策很重要。
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http://dx.doi.org/10.1136/gutjnl-2020-321040