肝切除术后辅助肝动脉灌注化疗是否能改善肝细胞癌患者的预后？一项荟萃分析。
Does adjuvant hepatic artery infusion chemotherapy improve patient outcomes for hepatocellular carcinoma following liver resection? A meta-analysis.
机构信息
Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China.
Department of Hepatopancreatobiliary Surgery, Taizhou Enze Medical Center (Group), Enze Hospital, Zhejiang, China.
出版信息
World J Surg Oncol. 2023 Apr 3;21(1):121. doi: 10.1186/s12957-023-03000-1.
BACKGROUND
Adjuvant hepatic artery infusion chemotherapy (HAIC) has been shown to be beneficial to the patient outcomes in hepatocellular carcinoma (HCC).
METHODS
Randomized controlled trials (RCTs) and non-RCTs were identified from six databases up to January 26, 2023. Patient outcomes were assessed using overall survival (OS) and disease-free survival (DFS). Data were presented as hazard ratios (HR, 95% confidence intervals, or CIs).
RESULTS
The present systematic review included 2 RCTs and 9 non-RCTs with a total of 1290 cases. Adjuvant HAIC improved OS (HR of 0.69; 95% CI of 0.56-0.84; p < 0.01) and DFS (HR of 0.64; 95% CI of 0.49-0.83; p < 0.01). Subgroup analysis showed that HCC patients with portal vein invasion (PVI) or microvascular invasion (MVI) benefit from adjuvant HAIC in terms of OS ((HR of 0.43; 95% CI of 0.19-0.95; p < 0.01) and (HR of 0.43; 95% CI of 0.19-0.95; p = 0.0373), respectively) and DFS ((HR of 0.38; 95% CI of 0.21-0.69; p < 0.01) and (HR of 0.73; 95% CI of 0.60-0.88; p = 0.0125), respectively). Adjuvant HAIC with the oxaliplatin-based approach significantly improved OS (HR of 0.60; 95% CI of 0.36-0.84; p = 0.02) and (HR of 0.59; 95% CI of 0.43-0.75; p < 0.01), respectively).
CONCLUSION
This meta-analysis demonstrated that postoperative adjuvant HAIC was beneficial in HCC patients with PVI and MVI. It remains unclear whether HAIC can improve the survival outcome in all HCC patients after hepatic resection.
背景
辅助肝动脉灌注化疗（HAIC）已被证明对肝细胞癌（HCC）患者的预后有益。
方法
从六个数据库中检索到截至 2023 年 1 月 26 日的随机对照试验（RCT）和非随机对照试验。使用总生存期（OS）和无病生存期（DFS）评估患者的预后。数据以风险比（HR，95%置信区间或 CI）呈现。
结果
本系统评价纳入了 2 项 RCT 和 9 项非 RCT，共 1290 例患者。辅助 HAIC 可改善 OS（HR 为 0.69；95%CI 为 0.56-0.84；p<0.01）和 DFS（HR 为 0.64；95%CI 为 0.49-0.83；p<0.01）。亚组分析显示，对于合并门静脉侵犯（PVI）或微血管侵犯（MVI）的 HCC 患者，辅助 HAIC 可改善 OS（HR 为 0.43；95%CI 为 0.19-0.95；p<0.01）和 DFS（HR 为 0.43；95%CI 为 0.19-0.95；p=0.0373），分别）和 DFS（HR 为 0.38；95%CI 为 0.21-0.69；p<0.01）和（HR 为 0.73；95%CI 为 0.60-0.88；p=0.0125），分别）。辅助奥沙利铂为基础的 HAIC 可显著改善 OS（HR 为 0.60；95%CI 为 0.36-0.84；p=0.02）和 DFS（HR 为 0.59；95%CI 为 0.43-0.75；p<0.01），分别）。
结论
本荟萃分析表明，术后辅助 HAIC 对合并 PVI 和 MVI 的 HCC 患者有益。HAIC 是否能提高所有 HCC 患者肝切除术后的生存结局尚不清楚。
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