Treatment of hepatocellular carcinoma with macroscopic vascular invasion: A systematic review and network meta-analysis

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews Pub Date : 2023-07-01 DOI:10.1016/j.trre.2023.100763

Francisco Tustumi , Fabricio Ferreira Coelho , Daniel de Paiva Magalhães , Sérgio Silveira Júnior , Vagner Birk Jeismann , Gilton Marques Fonseca , Jaime Arthur Pirola Kruger , Luiz Augusto Carneiro D'Albuquerque , Paulo Herman

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引用次数: 0

Abstract

Background

This study aimed to evaluate the outcomes of different treatments for patients with hepatocellular carcinoma (HCC) and macroscopic vascular invasion.

Methods

A systematic review and meta-analysis of comparative studies was performed to evaluate various treatment modalities for HCC with macroscopic vascular invasion, including liver resection (LR), liver transplantation (LT), transarterial chemoembolization (TACE), transarterial radioembolization (TARE), radiotherapy (RT), radiofrequency ablation (RFA), and antineoplastic systemic therapy (AnST).

Results

After applying the selection criteria, 31 studies were included. The surgical resection (SR) group (including LR and LT) had a similar mortality rate to the non-surgical resection (NS) group (RD = −0.01; 95% CI -0.05 to 0.03). The SR group had a higher rate of complications (RD = 0.06; 95% CI 0.00 to 0.12) but a higher 3-year overall survival (OS) rate than the NS group (RD = 0.12; 95% CI 0.05 to 0.20). The network analysis revealed that the overall survival was lower in the AnST group. LT and LR had similar survival benefits. The meta-regression suggested that SR has a greater impact on the survival of patients with impaired liver function.

Discussion

Most likely, LT has a significant impact on long-term survival and consequently would be a better option for HCC with macroscopic vascular invasion in patients with impaired liver function. LT and LR offer a higher chance of long-term survival than NS alternatives, although LR and LR are associated with a higher risk of procedure-related complications.

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肝细胞癌伴宏观血管侵犯的治疗:系统回顾和网络荟萃分析

背景本研究旨在评估肝细胞癌（HCC）和肉眼可见血管侵犯患者不同治疗的结果。方法对比较研究进行系统回顾和荟萃分析，以评估肝切除术（LR）、肝移植术（LT）、动脉化疗栓塞术（TACE）、动脉放射栓塞术（TARE）、放疗（RT）、射频消融（RFA）、，结果应用筛选标准后，纳入31项研究。手术切除（SR）组（包括LR和LT）的死亡率与非手术切除（NS）组相似（RD=−0.01；95%CI-0.05至0.03）。SR组的并发症发生率较高（RD=0.06；95%CI 0.00至0.12），但3年总生存率（OS）高于NS组（RD=0.12；95%CI 0.05至0.20）AnST组的存活率较低。LT和LR具有相似的生存益处。荟萃回归表明SR对肝功能受损患者的生存有更大的影响。讨论最有可能的是，LT对长期生存有重大影响，因此对于肝功能受损患者的肉眼可见血管侵犯的HCC来说，LT将是一个更好的选择。LT和LR比NS替代方案提供了更高的长期生存机会，尽管LR和LR与手术相关并发症的风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.