小于3 cm肝细胞肝癌3种亚型肝内转移与门静脉浸润发生率的Meta分析
| 作者: |
1何泽华,
1陆彩云,
2黎乐群,
3杨幸
1 广西中医药大学附属瑞康医院肝胆外科，南宁 530011 2 广西医科大学附属肿瘤医院肝胆外科，南宁 530021 3 武警广西总队医院外二科，南宁 530003 |
| 通讯: |
何泽华
Email: hezehua2000@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2014.02.005 |
摘要
目的：评估小于3 cm肝细胞肝癌Eggel's形态学分类各亚型的肝内转移和门静脉浸润发生率。方法：采用计算机检索PubMed，Cochrane，Embase，中国生物医学文献数据库，中国知网以及维普中文科技期刊数据库，同时手工检索《中华肿瘤杂志》《中华肝胆外科杂志》等相关杂志纳入肝细胞肝癌形态学分类各亚型肝内转移的病理特征研究。两位评价者独立对检索的文献进行筛选，并对纳入研究进行数据提取及偏倚风险评估，任何分歧意见通过讨论统一。方法学质量评估采用Newcastle-Ottawa量表评分，数据分析采用Revman5.2系统软件。结果： Meta分析表明小于3 cm肝细胞肝癌，单结节型(single nodular type，SN)与单结节结外生长型(single nodular with extranodular growth type，SNEG)或连续多结节型(contiguous multinodular，CM)门静脉浸润发生率之间差异有统计学意义[SN与SNEG：18.6%与47.4%, RR=0.37，95%CI (0.24，0.56)，P<0.001。SN与CM：18.6%与45.8%，RR=0.34，95%CI (0.23，0.50)，P<0.001]。SN与SNEG或CM肝内转移发生率之间差异有统计学意义[SN与SNEG：17.4%与38.2%，RR=0.24，95%CI (0.14，0.42)，P﹤0.001。SN与CM：17.4%与30.5%，RR=0.45，95%CI (0.29，0.72)，P=0.0008]。结论：SN与SNEG或CM比较在门静脉浸润发生率、肝内转移病灶发生率方面存在差异，临床上可根据各亚型的不同病理特点优化治疗方案。
关键词：
肝细胞肝癌；肝内转移；形态学分类；系统评价
Incidence rate of intrahepatic metastasis or portal vein invasion of 3 isoforms in less than 3 cm hepatocellular carcinoma: A Meta-analysis
CorrespondingAuthor: HE Zehua Email: hezehua2000@126.com
DOI: 10.3978/j.issn.2095-6959.2014.02.005
Abstract
Objective: To evaluate the incidence rate of intrahepatic metastasis or portal vein invasion in each isoform by Eggel’s morphological classification of hepatocellular carcinoma. Methods: Data in PubMed, Cochrane, Embase, China Biology Medicine disc (CBM), China Knowledge Resource Integrated Database (CNKI), and VIP Database for Chinese Technical Periodicals (VIP) were searched by computer. Meanwhile, Chinese Journal of Tumour, Chinese Journal of Hepatobiliary Surgery, and other relevant journals were searched by manual. Literature about pathologic features of intrahepatic metastasis of 3 isoforms classified by Morphology Classification of Hepatocellular Carcinoma was included. The screening of literature, the extraction of data, and the risk of bias assessment were independently finished by 2 authors, and any different opinions were resolved through discussion. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of selected studies in Meta-analysis. Revman software 5.2 was used for the analysis. Results: Meta-analysis showed that portal vein invasion in less than 3 cm hepatocellular carcinoma was statistically significant difference among single nodular (SN), contiguous multinodular (CM) and single nodular with extranodular growth (SNEG) type [SN vs SNEG: 18.6% vs 47.4%, RR=0.37, 95%CI (0.24, 0.56), P﹤0.001. SN vs CM: 18.6% vs 45.8%, RR=0.34, 95%CI (0.23, 0.50), P﹤0.001]. There were significant difference in intrahepatic metastasis among SN, SNEG, and CM [SN vs SNEG: 17.4% vs 38.2%, RR=0.24, 95%CI (0.14, 0.42), P﹤0.001. SN vs CM: 17.4% vs 30.5%, RR=0.45, 95%CI (0.29, 0.72), P=0.0008]. Conclusion: There are differences between SN and SNEG type or CM type in the incidence of portal vein invasion and intrahepatic metastasis. Better clinical treatment can be chosen according to the different pathological features.