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已发表论文
经动脉化疗栓塞与肝切除术在肝细胞癌治疗中的对比： 一项综合分析
Authors Tian X, Dai Y, Wang D, Zhang L, Sui C, Meng F, Jiang S, Liu Y, Jiang Y
Received 15 April 2015
Accepted for publication 29 May 2015
Published 10 August 2015 Volume 2015:9 Pages 4431—4440
DOI http://dx.doi.org/10.2147/DDDT.S86629
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Wei Duan
Background: A number of cohort studies have compared the outcomes of transarterial chemoembolization (TACE) and hepatic resection (HR) in the treatment of hepatocellular carcinoma (HCC). However, the effect of TACE versus HR remains controversial. Therefore, we conducted a meta-analysis to assess the effectiveness of TACE and HR in HCC treatment.
Materials and methods: PubMed, Embase, Web of Science, Scopus, ClinicalTrials.gov, and Cochrane library were searched from their inception until February 27, 2015 for relevant studies. The literature search was updated on May 25, 2015. Eligible studies were cohort
studies comparing the survival outcomes between HCC patients undergoing TACE and HR. The primary outcome was overall survival (OS). Secondary outcomes were the recurrence rate and prognostic factors for OS. The risk ratio (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (CIs).
Results: This meta-analysis included eleven cohort studies with 6,297 patients, all treated with TACE or HR. Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63–0.93; P =0.009). TACE and HR had similar effects on OS after 1 year (RR =0.94; 95% CI, 0.86–1.01; P =0.103), 2 years (RR =0.50; 95% CI, 0.21–1.19; P =0.114), 4 years (RR =0.61; 95% CI, 0.58–1.10; P =0.174), and 5 years (RR =0.77; 95% CI, 0.59–1.01; P =0.06). There was no significant difference between the 3-year (RR =1.31; 95% CI, 0.65–2.64; P =0.457) and 5-year recurrence rates (RR =1.14; 95% CI, 0.69–1.89; P =0.597) in the TACE and HR groups. Age (>65 vs ≤65 years; hazard ratio =0.99; 95% CI, 0.98–1.00; P =0.000), sex (male vs female; hazard ratio =0.79; 95% CI, 0.65–0.96; P =0.02),treatment method (TACE vs HR; hazard ratio =1.90; 95% CI, 1.46–2.46; P =0.000), and Eastern Cooperative Oncology Group performance score (≥1 vs 0; hazard ratio =1.69; 95% CI, 1.22–2.33; P =0.002) were independent predictors for OS.
Conclusion: This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate. However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).
Keywords: transarterial chemoembolization, hepatic resection, hepatocellular carcinoma, meta-analysis
Materials and methods: PubMed, Embase, Web of Science, Scopus, ClinicalTrials.gov, and Cochrane library were searched from their inception until February 27, 2015 for relevant studies. The literature search was updated on May 25, 2015. Eligible studies were cohort
studies comparing the survival outcomes between HCC patients undergoing TACE and HR. The primary outcome was overall survival (OS). Secondary outcomes were the recurrence rate and prognostic factors for OS. The risk ratio (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (CIs).
Results: This meta-analysis included eleven cohort studies with 6,297 patients, all treated with TACE or HR. Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63–0.93; P =0.009). TACE and HR had similar effects on OS after 1 year (RR =0.94; 95% CI, 0.86–1.01; P =0.103), 2 years (RR =0.50; 95% CI, 0.21–1.19; P =0.114), 4 years (RR =0.61; 95% CI, 0.58–1.10; P =0.174), and 5 years (RR =0.77; 95% CI, 0.59–1.01; P =0.06). There was no significant difference between the 3-year (RR =1.31; 95% CI, 0.65–2.64; P =0.457) and 5-year recurrence rates (RR =1.14; 95% CI, 0.69–1.89; P =0.597) in the TACE and HR groups. Age (>65 vs ≤65 years; hazard ratio =0.99; 95% CI, 0.98–1.00; P =0.000), sex (male vs female; hazard ratio =0.79; 95% CI, 0.65–0.96; P =0.02),treatment method (TACE vs HR; hazard ratio =1.90; 95% CI, 1.46–2.46; P =0.000), and Eastern Cooperative Oncology Group performance score (≥1 vs 0; hazard ratio =1.69; 95% CI, 1.22–2.33; P =0.002) were independent predictors for OS.
Conclusion: This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate. However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).
Keywords: transarterial chemoembolization, hepatic resection, hepatocellular carcinoma, meta-analysis
