SNFGE SNFGE
 
Thématique :
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/09  
 
  2018 Sep;68(3):977-993.  
  doi: 10.1002/hep.29883.  
 
  Hepatic resection compared to chemoembolization in intermediate- to advanced-stage hepatocellular carcinoma: A meta-analysis of high-quality studies.  
 
  Hyun MH, Lee YS, Kim JH, Lee CU, Jung YK, Seo YS, Yim HJ, Yeon JE, Byun KS  
  https://www.ncbi.nlm.nih.gov/pubmed/29543988  
 
 

Abstract
 

According to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines for hepatocellular carcinoma (HCC), the role of surgery has been expanded beyond the Barcelona Clinic Liver Cancer (BCLC) algorithm. We compared primary hepatectomy (PH) with transarterial chemoembolization (TACE) in patients with intermediate- to advanced-stage (BCLC stage B/C) HCC to determine the current evidence. Through a database search, we included 18 high-quality studies (one randomized controlled trial [RCT], five propensity-score matching nonrandomized comparative trials [NRCTs], and 12 NRCTs) that compared survival outcomes of 5,986 patients after PH and TACE. We found significant survival benefits for PH over TACE in BCLC stage B/C patients (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.51-0.67; P < 0.00001; I2 = 84%). According to the BCLC, both stage B and stage C patients showed significantly better overall survival (OS) for PH compared to TACE (HR, 0.53; 95% CI, 0.43-0.65; P < 0.00001; I2 = 77%; HR, 0.67; 95% CI, 0.59-0.77; P < 0.00001; I2 = 79%, respectively). Five-year survival rates for PH were significantly higher than those for TACE in BCLC stage B/C, stage B, and BCLC stage C patients (odds ratio [OR], 2.71, 2.77, and 3.03, respectively; all P < 0.00001). Survival benefits persisted across subgroup, sensitivity, and metaregression analyses; interstudy heterogeneity remained constant.

CONCLUSION:

This meta-analysis suggests that surgical resection provides survival benefits in patients with intermediate- to advanced-stage HCC. The evidence found herein may assist in the choice of treatment modality based on diverse definitions of operability. (Hepatology 2018).

 
 
Question posée
 
Comparer l’hépatectomie « primaire » à la chimioembolisation (TACE) chez les patients ayant un cracinome hépatocellulaire (CHC) de stade intermédiaire ou avancé (BCLC stade B/C) HCC afin de préciser quel est le meilleur traitement à partir d’une méta-analyse permettant d’évaluer le traitement de près de 6000 patients.
 
Question posée
 
La chirurgie fait mieux en termes de survie chez ces patients BCLC B/C. La survie à 5 ans est augmentée quelque soit le stade B et C et les 2 stades confondus et ceci de façon très significative (OR de 2,7 à 3,0).
 
Commentaires

A bien lire pour les décisions de RCP.

 
www.snfge.org