Is It Just a Matter of Surgical Extension to Achieve the Cure of Hepatocarcinoma? A Meta-Analysis of Propensity-Matched and Randomized ... View Full Text


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Article Info

DATE

2020-01-02

AUTHORS

Simone Famularo, Marco Ceresoli, Alessandro Giani, Cristina Ciulli, Enrico Pinotti, Fabrizio Romano, Marco Braga, Luciano De Carlis, Luca Gianotti

ABSTRACT

BackgroundThe benefit of anatomic (AR) versus parenchyma-sparing resection (PSR) in hepatocarcinoma (HCC) is still debated. The aim of the study was to compare AR vs. PSR in terms of overall survival (OS) and disease-free survival (DFS).MethodsA systematic review was conducted using Medline and Google Scholar. To reduce intra- and inter-study heterogeneity, only propensity-matched studies and randomized clinical trials (RCT) were evaluated and a generic inverse variance meta-analysis was run. A sub-analysis was performed in case of tumor microvascular invasion (MVI).ResultsEleven propensity-matched and one RCT were evaluated, with a total of 3445 patients (AR = 1776 and PSR = 1669). Tumor burden and liver function were comparable among studies (I2 < 50%, p > 0.5). OS was similar between AR and PSR (HR 0.93; 95%CI, 0.75–1.15; p = 0.50, I2 = 41%). DFS was improved in AR at 1 year (RR 0.84; 95%CI, 0.72–0.97; p = 0.02; I2 = 36%) and 3 years (RR 0.90; 95%CI, 0.83–0.98; p = 0.02; I2 = 40%) but not at 5 years (RR 0.94; 95%CI, 0.87–1.01; p = 0.07; I2 = 41%). Furthermore, in the presence of MVI, no difference in OS and DFS was observed between AR and PSR.ConclusionWhen liver function and tumor burden are comparable, AR and PSR achieved similar overall survival. AR improved local control in the early period after surgery. Furthermore, in the presence of MVI, the extension of surgery was not associated with better OS and DFS. More... »

PAGES

94-103

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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s11605-019-04494-5

    DOI

    http://dx.doi.org/10.1007/s11605-019-04494-5

    DIMENSIONS

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    23 schema:description BackgroundThe benefit of anatomic (AR) versus parenchyma-sparing resection (PSR) in hepatocarcinoma (HCC) is still debated. The aim of the study was to compare AR vs. PSR in terms of overall survival (OS) and disease-free survival (DFS).MethodsA systematic review was conducted using Medline and Google Scholar. To reduce intra- and inter-study heterogeneity, only propensity-matched studies and randomized clinical trials (RCT) were evaluated and a generic inverse variance meta-analysis was run. A sub-analysis was performed in case of tumor microvascular invasion (MVI).ResultsEleven propensity-matched and one RCT were evaluated, with a total of 3445 patients (AR = 1776 and PSR = 1669). Tumor burden and liver function were comparable among studies (I2 < 50%, p > 0.5). OS was similar between AR and PSR (HR 0.93; 95%CI, 0.75–1.15; p = 0.50, I2 = 41%). DFS was improved in AR at 1 year (RR 0.84; 95%CI, 0.72–0.97; p = 0.02; I2 = 36%) and 3 years (RR 0.90; 95%CI, 0.83–0.98; p = 0.02; I2 = 40%) but not at 5 years (RR 0.94; 95%CI, 0.87–1.01; p = 0.07; I2 = 41%). Furthermore, in the presence of MVI, no difference in OS and DFS was observed between AR and PSR.ConclusionWhen liver function and tumor burden are comparable, AR and PSR achieved similar overall survival. AR improved local control in the early period after surgery. Furthermore, in the presence of MVI, the extension of surgery was not associated with better OS and DFS.
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    32 ConclusionWhen liver function
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    37 MethodsA systematic review
    38 Parenchyma-Sparing Liver Resection
    39 Propensity-Matched
    40 RCTs
    41 ResultsEleven
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    43 aim
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    46 burden
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    50 cure
    51 differences
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    59 heterogeneity
    60 inter-study heterogeneity
    61 intra
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    64 liver function
    65 liver resection
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    67 matter
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    73 presence
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