自发性破裂肝细胞癌手术切除后长期生存的Meta分析  

Meta-analysis of long-term survival in patients with spontaneous rupture of hepatocellular carcinoma after hepatectomy

作　　者：章静[1] 黄小准 黄璋侃 徐林 殷鑫 毕新宇 车旭 倪勇[4] Zhang Jing;Huang Xiaozhun;Huang Zhangkan;Xu Lin;Yin Xin;Bi Xinyu;Che Xu;Ni Yong(Department of Chinese Medicine,Second People's Hospital,First Affiliated Hospital of Shenzhen University,Shenzhen 518035,Guangdong,China;Department of Hepatological Surgery,National Cancer Center/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,Guangdong,China;Department of Hepatological Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Hepatopancreatobiliary Surgery,Second People's Hospital,First Affiliated Hospital of Shenzhen University,Shenzhen 518035,Guangdong,China)

机构地区：[1]深圳市第二人民医院/深圳大学第一附属医院中医科,广东深圳518035 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院肝胆外科,广东深圳518116 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京100021 [4]深圳市第二人民医院/深圳大学第一附属医院肝胆胰外科,广东深圳518035

出　　处：《肝癌电子杂志》2024年第4期42-49,共8页Electronic Journal of Liver Tumor

基　　金：深圳市“医疗卫生三名工程”项目资助(SZSM202011010);深圳市高水平医院建设专项经费;中国医学科学院肿瘤医院深圳医院院内科研课题(E010322004)。

摘　　要：目的:通过Meta分析,评估自发性破裂对肝细胞癌(hepatocellular carcinoma,HCC)患者手术切除后长期生存的影响。方法:从建库至2020年1月14日,系统检索PubMed、OVID、Web of Science、Embase及Cochrane Library等数据库,通过纳入和排除标准筛选出比较自发性破裂的肝细胞癌(rupture HCC,rHCC)和未发生破裂的肝细胞癌(non-rupture HCC,nrHCC)的合格研究,并使用Review Manager v5.3软件对报道的数据进行统计汇总。结果:共纳入9项回顾性研究,总样本量为3144例,rHCC组患者总生存率和无病生存率均低于nrHCC组患者。对高质量的5项进行了倾向性匹配分析的研究进行亚组分析,1、3、5年总生存率的风险比(hazard ratio,HR)分别为5.30[95%置信区间(95%confidence intervals,95%CI)为3.42~8.22]、5.76(95%CI为4.24~7.81)和4.20(95%CI为3.20~5.51),1、3、5年无病生存率的HR分别为3.68(95%CI为2.67~5.07)、3.87(95%CI为2.99~5.02)和3.72(95%CI为2.93~4.72)。结论:Meta分析结果表明,rHCC患者总生存率及无病生存率均明显低于nrHCC患者。自发性破裂是影响HCC患者手术切除后长期生存预后的重要因素。Objective:Spontaneous rupture of hepatocellular carcinoma(HCC)is associated with high mortality rates,and hepatic resection can provide better outcomes than other available treatments.However,whether HCC rupture affects tumor recurrence and patient survival remains controversial.Method:From inception to January 14,2020.The electronic databases of PubMed,OVID,Web of Science,Embase,and the Cochrane Library were searched from the date of database inception until January 14,2020,and studies reporting survival outcomes with comparison between rupture HCC(rHCC)and non-rupture HCC(nrHCC)were included.The reported data were statistically summarized using Review Manager V5.3.Result:A total of 3144 patients from nine cohort studies were included.The overall survival(OS)and disease-free survival(DFS)were lower in the rHCC group than in the nrHCC group.The subgroup analysis of high-quality propensity-matched analyses to investigate the true impact of rupture on DFS and OS between the rHCC and nrHCC groups with no heterogeneity.The 1,3,and 5 years hazard ratios(HR)of OS were 5.30(95%confidence interval[95%CI]:3.42-8.22),5.76(95%CI:4.24-7.81),and 4.20(95%CI:3.20-5.51),respectively.The HR of 1,3 and 5 years DFS were 3.68(95%CI:2.67-5.07),3.87(95%CI:2.99-5.02)and 3.72(95%CI:2.93-4.72),respectively.Conclusion:The present Meta-analysis demonstrated that the DSF and OS were significantly lower in the rHCC group than in the nrHCC group and that spontaneous HCC rupture was a predictor of poor survival outcomes.

关 键 词：肝细胞癌 肝切除术 自发性破裂 生存 荟萃分析 

分 类 号：R73[医药卫生—肿瘤]