肝移植术前经导管肝动脉栓塞化疗对肝细胞癌患者疗效的系统评价  

Systematic review of the efficacy of preoperative transarterial chemoembolization for patients with hepatocelhlar carcinoma treated with liver transplantation

作　　者：王洪良 黄晨 黄良飞 侯善升 刘飞 乔鹏飞 刘越 贾婷婷 孙煦勇 Wang Hongliang;Huang Chen;Huang Liangfei;Hou Shansheng;Liu Fei;Qiao Pengfei;Liu Yue;Jia Tingting;Sun Xuyong(Department of Organ Transplantation,923th Hospital of PLA Joint Logistic Support Force,Nanning 530000,China;Transplant Medical Center,Second Affiliated Hospital of Guangxi Medical University,Nanning 530000,China)

机构地区：[1]解放军联勤保障部队第九二三医院器官移植科,南宁530000 [2]广西医科大学第二附属医院移植医学中心,南宁530000

出　　处：《中华肝胆外科杂志》2024年第4期291-296,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：广西科学研究与技术开发计划(桂科攻14124003-8);广西卫生健康委员会自筹课题(Z20180575、Z-A20231058)。

摘　　要：目的评价肝移植术前经导管肝动脉栓塞化疗(TACE)对肝细胞癌患者的疗效。方法计算机检索PubMed、EMbase、Cochrane数据库、中国知网、万方数据库1990年1月1日至2023年10月31日比较肝细胞癌患者肝移植术前是否行TACE的病例对照研究。提取信息包括:研究者、发表年份、病例数、年龄、性别、干预措施、结局指标等。采用Revman 5.4软件进行统计分析,采用比值比(OR)和95%可信区间(CI)表示统计效应量。结果共纳入15篇研究,共1172例患者,其中男性1000例,女性172例。依据术前是否行TACE分为两组:TACE组(n=654)和非TACE组(n=518)。荟萃分析结果显示,TACE组患者的1年生存率(OR=2.12,95%CI:1.30~3.46)和5年生存率(OR=1.46,95%CI:1.07~1.99)均优于非TACE组,差异有统计学意义(均P<0.05);TACE组患者的1年无瘤生存率(OR=1.80,95%CI:1.10~2.95)和5年无瘤生存率(OR=1.48,95%CI:1.03~2.14)均优于非TACE组,差异有统计学意义(均P<0.05)。结论肝细胞癌患者在肝移植术前行TACE相对于直接肝移植患者,在术后生存率及无瘤生存率上有优势。但考虑到器官移植为急诊手术的特殊性,在有合适供肝的情况下仍需及时行肝移植。Objective To evaluate the efficacy of preoperative transarterial chemoembolization(TACE)for patients with hepatocellular carcinoma(HCC)treated with liver transplantation.Methods Information from 1 January 1990 to 31 October 2023 was retrieved from PubMed,EMbase,Cochrane library,CNKI,WanFang database.Collected publications were all about case-control study of preoperative TACE or not to HCC.The extracted information included:investigator,year of publication,number of cases,age,gender,intervention measures,outcome indicators,etc.Statistical analysis was performed using Revman 5.4,and odds ratio(OR)and 95%confidence interval(CI)were used to represent the statistical effect size.Results A total of 15 articles including 1172 patients were enrolled,of these,1000 were males and 172 were females.They were divided into two groups according to whether preoperative TACE was performed,TACE group(n=654),non-TACE group(n=518).The results of the meta-analysis showed that the 1-year(OR=2.12,95%CI:1.30-3.46)and 5-year(OR=1.46,95%CI:1.07-1.99)survival rates in the TACE group were better than those in the non-TACE group,and the difference was statistically significant(all P<0.05).On the disease-free survival,1-year(OR=1.80,95%CI:1.10-2.95)and 5-year(OR=1.48,95%CI:1.03-2.14)in TACE group were also better than non-TACE group(all P<0.05).Conclusions The efficacy of preoperative TACE is superior to that of direct liver transplantation in the treatment of hepatocellular carcinoma,including postoperative survival rate and tumor-free survival rate.However,considering the particularity of organ transplantation as an emergency operation,it is still necessary to perform liver transplantation in time when there is a suitable liver donor.

关 键 词：癌 肝细胞 肝移植 肝动脉化疗栓塞 系统评价 

分 类 号：R735.7[医药卫生—肿瘤]