目的:大原发性肝细胞癌(HCC)死亡率高,治疗方法多样。手术和经导管动脉化疗栓塞(TACE)是重要的治疗方法。哪个可以更好地保持争议。该研究的目的是比较大肝癌患者手术切除(SR)和使用TACE的长期总生存率。
方法:我们通过PubMed评估临床试验,Medline,Embase,和Cochrane图书馆直到2022年3月。两名研究人员独立筛选文章,提取的数据,并根据PRISMA(系统评价和荟萃分析的首选报告项目)指南评估研究质量。主要结果是总生存期(OS)。次要结果是倾向评分匹配(PSM)后的OS和无进展生存期(PFS)。
结果:共14项研究,包括3609名病人,纳入荟萃分析。荟萃分析表明,1年OS有显著改善,3年操作系统,和5年OS倾向于SR优于TACE(OR=2.19,95%CI1,60-3.00;OR=3.47,95%CI2.47-4.88;OR=2.72,95%CI2.03-3.64,p<0.001,随机模型)。结果在肿瘤大小和肿瘤数量的亚组之间是一致的(p>0.05)。汇总结果表明,1年OS,3年操作系统,与TACE组相比,SR组PSM后5年OS较高(p<0.001)。
结论:这项荟萃分析表明,在大型原发性肝癌患者中,手术切除患者的总生存率高于TACE患者.
Large primary hepatocellular carcinoma (HCC) has a high mortality rate and a variety of treatments. Surgery and transcatheter arterial chemoembolization (TACE) are important treatments. Which could be better remain debatable. The objective of the study is to compare the long-term overall survival of surgical resection (
SR) and the use of TACE in patients with large hepatocellular carcinoma.
We assessed clinical trials through PubMed, Medline, Embase, and the Cochrane Library up to March 2022. Two researchers independently screened articles, extracted data, and assessed the study quality according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)guidelines. The primary outcome was overall survival (OS). The secondary outcomes were OS after propensity scores matching (PSM) and progression-free survival (PFS).
A total of 14 studies, including 3609 patients, were enrolled in the meta-analysis. The meta-analysis indicated a significant improvement in the 1-year OS, 3-year OS, and 5-year OS favoring
SR over TACE (OR = 2.19, 95% CI 1,60-3.00; OR = 3.47, 95% CI 2.47-4.88; OR = 2.72, 95% CI 2.03-3.64, p < 0.001, random model). The results were consistent across subgroups of tumor size and tumor numbers (p > 0.05). The pooled outcome indicated that 1-year OS, 3-year OS, and 5-year OS after PSM were higher in the
SR group than in the TACE group (p < 0.001).
This meta-analysis indicates that among patients with large primary hepatocellular carcinoma, the overall survival rate of patients undergoing surgical resection was higher than that of patients undergoing TACE.