荷瘤门脉流域完全切除对肝细胞癌患者术后生存影响的荟萃分析

Effect of Complete Removal of the Tumor-Bearing Portal Territory on Prognosis of Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

摘要: 目的：选择接受肝切除的肝细胞癌，评价解剖性肝切除和非解剖性肝切除对患者预后的影响。方法：应用计算机检索PubMed、Cochrane Library、EMBASE数据库中2010年1月至2021年3月关于肝细胞癌接受解剖性肝切除与非解剖性切除的文章，对患者一般特征、肿瘤特征、手术特征和远期预后进行系统评价。结果：共纳入11项病例对照研究，2471例患者，其中解剖性肝切除组1252例，非解剖性肝切除组1219例。和非解剖性肝切除组比较，解剖性肝切除组基线特征为吲哚青绿15分钟滞留率数值更小、手术时间更长、术中失血量更多。长期预后方面，与非解剖性肝切除组相比，解剖性肝切除组获得了更好的术后5年无瘤生存率[比值比(OR) = 1.40，95% CI：1.06~1.84，P = 0.016]，而在5年总体生存率方面，两种术式无显著差异[OR = 1.23, 95% CI: 0.96~1.59, P = 0.106]。结论：解剖性肝切除对于降低肝细胞癌患者远期复发显著优于非解剖性肝切除。

Abstract: Objective: Hepatocellular carcinoma undergoing hepatectomy was selected to evaluate the effect of anatomical hepatectomy and non-anatomical hepatectomy on the prognosis of patients. Methods: PubMed, EMBASE and Cochrane Library databases were searched for articles on AR and NAR from January 2010 to March 2021. Meta-analysis was performed on patient characteristics, tumor characteristics, surgical characteristics and long-term prognosis. Results: A total of 11 case-control studies were included in this study, including 2471 patients: there were 1252 cases in the AR group and 1219 cases in the NAR group. Compared with the NAR group, the AR group had lower ICG R15 value, longer operation time and higher intraoperative blood loss. Compared with the NAR group, the AR group achieved a better postoperative 5-year disease-free survival rate [OR = 1.40, 95% CI: 1.06~1.84, P = 0.016], but there was no significant difference in the 5-year overall survival rate between the two groups [OR = 1.23, 95% CI: 0.96~1.59, P = 0.106]. Conclusions: AR is significantly better than NAR for reducing long-term recurrence in HCC.