肝细胞癌术前经动脉化疗栓塞的疗效和安全性：系统评价和

StephenW

肝细胞癌术前经动脉化疗栓塞的疗效和安全性：系统评价和荟萃分析
时正弥
, 杨聂
& 谢长明
兽人图标
2022年1月17日接收，2022年3月20日接受，在线发表：2022年4月2日

    下载引文 https://doi.org/10.1080/00365521.2022.2057198 CrossMark Logo CrossMark

抽象的
客观的

本研究的目的是比较肝细胞癌 (HCC) 的术前经导管动脉化疗 (TACE) 加肝切除术 (LR) 与单纯肝切除术 (LR)。
材料和方法

从 PubMed、Embase、Cochrane 图书馆、科学网和中国知识基础设施 (CNKI) 开始搜索到 2021 年 8 月 24 日。符合条件的语言是英文和中文。本研究仅包括 RCT 和队列研究。主要结局是预后因素，包括总生存率（OS）、无病生存期（DFS）、无复发生存期（RFS），我们还研究了手术时间、术中失血量和术后并发症。
结果

共纳入 29 项试验（2 个 RCT 和 27 个队列），共纳入 22023 名患者，与肝切除术相比，术前 TACE 加 LR 显示 RFS 的益处（风险比（HR）=0.80，95%CI = [0.73 –0.88], p < .001)，联合治疗与巴塞罗那临床肝癌 (BCLC) B 期 HCC 患者的更高 OS 相关（HR = 0.76, 95%CI = [0.60–0.96], p = .024）。在安全性方面，联合治疗与较少的术中失血有关（加权平均差 (WMD)=-11.17, 95%CI = [-21.79 to -0.54], p = .039）；术后并发症（风险比（RR）=0.99, 95%CI= [0.90-1.08], p = 0.771）和手术时间（WMD=7.57, 95%CI = [-5.07 to 20.20]）无统计学意义， p = .240)。
结论

鉴于其对 RFS 和 OS 的益处，应推荐术前 TACE 作为 HCC 患者的常规治疗，尤其是 BCLC B 期 HCC。应该进行大型、多中心和盲法随机试验来证实这些发现。

关键词：肝细胞癌荟萃分析经导管动脉化疗栓塞肝切除术

StephenW

Efficacy and safety of preoperative transarterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis
Shizheng Mi
, Yang Nie
& Changming Xie
ORCID Icon
Received 17 Jan 2022, Accepted 20 Mar 2022, Published online: 02 Apr 2022

    Download citation https://doi.org/10.1080/00365521.2022.2057198 CrossMark Logo CrossMark

Abstract
Objective

The aim of the study was to compare preoperative transcatheter arterial chemotherapy (TACE) plus liver resection (LR) with liver resection (LR) alone for hepatocellular carcinoma (HCC).
Materials and methods

PubMed, Embase, Cochrane library, web of science and China National Knowledge Infrastructure (CNKI) were searched from their initiation until 24 August 2021. Eligible languages were English and Chinese. This study includes only RCT and cohort studies. The primary outcome was the prognostic factors including overall survival rate (OS), disease-free survival (DFS), recurrence-free survival (RFS), and we also research the operative time, intraoperative blood loss, and postoperative complication.
Results

Twenty-nine trials (2 RCTs and 27 cohorts) were included, containing a total of 22023 patients, compared with hepatic resection, preoperative TACE plus LR shows the benefit of RFS (Hazard Ratio (HR)=0.80, 95%CI = [0.73–0.88], p < .001), and the combined therapy was associated with a higher OS for patients with HCC in Barcelona Clinic Liver Cancer (BCLC) B stage (HR = 0.76, 95%CI = [0.60–0.96], p = .024). In terms of safety, combination therapy is related to less intraoperative blood loss (Weighted Mean Difference (WMD)=-11.17, 95%CI = [-21.79 to −0.54], p = .039); and there’s no statistical significance in postoperative complication (Risk Ratio (RR)=0.99, 95%CI= [0.90–1.08], p = 0.771) and operative time (WMD = 7.57, 95%CI = [-5.07 to 20.20], p = .240).
Conclusion

TACE prior to surgery should be recommended as a routine treatment for HCC patients, especially BCLC B stage HCC, in view of its benefits for RFS and OS. Large, multicenter, and blinded randomized trials should be performed to confirm these findings.

Keywords: Hepatocellular carcinomameta-analysistranscatheter arterial chemoembolizationhepatectomy