Oncological outcomes of tumor ablation compared to surgical resection in early-stage hepatocellular carcinomas: a systematic review with meta-analysis

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-12-01 DOI:10.1016/j.hpb.2024.08.008

Janyssa Charbonneau , Thomas Couture , Alexis Turgeon , Sarah O'Connor , Jean-François Ouellet , Jean-François Berthin Ouellet , Alexandre Brind’Amour

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引用次数: 0

Abstract

Background

The optimal choice of treatment for early-stage hepatocellular carcinomas (HCC) remains controversial, with recent conflicted guidelines. This systematic review evaluated whether ablation is oncologically non-inferior to surgical resection.

Methods

We performed a systematic search of the EMBASE, MEDLINE, CENTRAL and Web of Science databases to identify randomized controlled trials comparing tumor ablation and surgical resection for early-stage HCCs. A non-inferiority margin of 5% (RR 0.93) for overall survival (OS) was considered, following a consensus of clinical experts.

Results

We identified 5829 citations from which 11 trials (n = 1736) were included. The non-inferiority of tumor ablation was not observed for OS (RR 0.92; 95%CI 0.85–1.00,I² = 33%). Recurrence-free survival was reduced with ablation (RR 0.80; 95%CI 0.69–0.93,I² = 49%). There was no difference in terms of extra-hepatic recurrence and minor complications. Tumor ablation was associated with decreased overall morbidity (RR 0.43; 95%CI 0.30–0.62,I² = 31%) and major complications (RR 0.22; 95%CI 0.07–0.71,I² = 66%). Intra-hepatic recurrence was higher with ablation (RR 1.28; 95%CI 1.10–1.48,I² = 12%). Certainty of evidence was low to moderate.

Conclusion

We did not observe the oncological non-inferiority of tumor ablation when compared to surgical resection. Nevertheless, most analyses were of low quality of evidence, including the overall survival. We cannot exclude that the true effect of tumor ablation is different than the currently observed one.

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早期肝细胞癌中肿瘤消融术与手术切除术的肿瘤学疗效比较：系统综述与荟萃分析

早期肝细胞癌（HCC）的最佳治疗选择仍存在争议，近期的指导方针也相互矛盾。本系统性综述评估了消融在肿瘤学上是否不劣于手术切除。我们对 EMBASE、MEDLINE、CENTRAL 和 Web of Science 数据库进行了系统检索，以确定对早期 HCCs 进行肿瘤消融和手术切除比较的随机对照试验。根据临床专家的共识，总生存期（OS）的非劣效差值为 5%（RR 0.93）。我们从中发现了 5829 条引文，并纳入了 11 项试验（n = 1736）。未观察到肿瘤消融对 OS 的非劣效性（RR 0.92；95%CI 0.85-1.00，I = 33%）。消融术降低了无复发生存率（RR 0.80；95%CI 0.69-0.93，I = 49%）。肝外复发和轻微并发症方面没有差异。肿瘤消融与总发病率（RR 0.43；95%CI 0.30-0.62，I = 31%）和主要并发症（RR 0.22；95%CI 0.07-0.71，I = 66%）的降低有关。消融术的肝内复发率较高（RR 1.28；95%CI 1.10-1.48，I = 12%）。证据的确定性为中低。与手术切除相比，我们没有观察到肿瘤消融的肿瘤学非劣效性。不过，大多数分析的证据质量较低，包括总生存率。我们不能排除肿瘤消融术的真实效果与目前观察到的效果不同。

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

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).