PO.TB07.03 · 肿瘤生物学
手术切除与非手术治疗用于伴门静脉癌栓的肝细胞癌：一项全面的系统评价和荟萃分析
Surgical resection versus non-surgical treatment for hepatocellular carcinoma with portal vein tumor thrombosis: A comprehensive systematic review and meta-analysis
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摘要 Abstract
中文摘要
背景：手术切除（SR）作为伴门静脉癌栓（PVTT）的肝细胞癌（HCC）的主要治疗手段的作用仍不确定。方法：对2000年1月至2024年4月的电子数据库进行全面检索，识别出比较SR与经动脉化疗栓塞（TACE）、TACE联合放疗（TACE-RT）或索拉非尼（sorafenib）的研究。对至少有三项符合条件研究的比较组进行荟萃分析。从Kaplan-Meier曲线中提取或重建总生存期（OS）的风险比（HR）及95%置信区间（CI）。结果：纳入了12项回顾性队列研究，涉及4,498例患者。SR在Vp1-2（5年OS：HR 0.53，95% CI 0.35-0.79）和Vp3（5年OS：HR 0.68，95% CI 0.61-0.75）中相比TACE显示出更优的长期OS，在Vp4中结局相当。SR与TACE-RT的1年和3年OS相似，尽管SR在Vp1-3 PVTT中显示出明显的5年OS优势（HR 0.48，95% CI 0.31-0.74）。与索拉非尼相比，SR在Vp1-2中提供更优的OS（3年OS：HR 0.26，95% CI 0.18-0.38），在Vp3中OS相当。敏感性分析支持了这些发现的稳健性，未检测到实质性的发表偏倚。结论：基于当前证据，在伴PVTT的HCC患者中，SR不劣于包括TACE、TACE-RT和索拉非尼在内的非手术治疗，并提供有意义的长期生存获益，尤其是在节段性PVTT（Vp1-Vp2）患者中。未来研究需要纳入免疫治疗的进一步比较研究。关键词：肝细胞癌；癌栓；切除；经动脉化疗栓塞；荟萃分析。
查看英文原文 English abstract
Background: The role of surgical resection (SR) as a primary treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains uncertain.
Methods: A comprehensive search of electronic databases from January 2000 to April 2024 identified studies comparing SR with transarterial chemoembolization (TACE), combined TACE and radiation therapy (TACE-RT), or sorafenib. Meta-analyses were conducted for comparison groups with at least three eligible studies. Hazard ratios (HRs) with 95 percent confidence intervals (CIs) for overall survival (OS) were extracted or reconstructed from Kaplan-Meier curves.
Results: Twelve retrospective cohort studies involving 4,498 patients were included. SR demonstrated superior long-term OS compared with TACE in Vp1-2 (5-year OS: HR 0.53, 95% CI 0.35-0.79) and Vp3 (5-year OS: HR 0.68, 95% CI 0.61-0.75), with comparable outcomes in Vp4. SR and TACE-RT showed similar 1- and 3-year OS, although SR demonstrated a clear 5-year OS advantage in Vp1-3 PVTT (HR 0.48, 95% CI 0.31-0.74). Compared with sorafenib, SR provided superior OS in Vp1-2 (3-year OS: HR 0.26, 95% CI 0.18-0.38) and comparable OS in Vp3. Sensitivity analyses supported the robustness of these findings, and no substantial publication bias was detected.
Conclusion: Based on current evidence, SR is not inferior to non-surgical treatments including TACE, TACE-RT, and sorafenib in patients with HCC and PVTT and provides meaningful long-term survival benefits, particularly in those with segmental PVTT (Vp1-Vp2). Further comparative studies incorporating immunotherapy are needed in future research.
Key words: Hepatocellular carcinoma; tumor thrombosis; resection; transarterial chemoembolization; meta-analysis.
利益披露 Disclosure
S. Kim, None..
S. Kim, None.