Background/purpose of the study

Laparoscopic hepatectomy (LH) has been widely used in the treatment of hepatocellular carcinoma (HCC). It is generally believed that the long-term outcomes of LH are not inferior to open hepatectomy (OH). However, the quality of evidence is low. The purpose of this study was to reconstruct time-to-event data for meta-analysis based on Kaplan–Meier curves from propensity-score matched studies and compare survival rates following LH and OH for hepatocellular carcinoma.

Methods

All published propensity-score matched studies reported in English that compared LH and OH for hepatocellular carcinoma with Kaplan–Meier curves were screened. Patients’ survival information was reconstructed with the aid of a computer vision program. Different models (fixed-effects model for two-stage survival analysis and Cox regression for one-stage survival analysis) were performed for sensitivity analysis. In addition to the primary meta-analysis, two specific subgroup analyses were performed on patients by types of resection, cirrhosis status.

Results

Time-to-event data were extracted from 45 propensity-score matched studies (N = 8905). According to the time-to-event data and the reconstructed Kaplan–Meier curves, the cumulative overall survival rate was 49.0% and 50.9% in the LH and OH cohorts, respectively, a log-rank test did not demonstrate statistical significance (p > 0.05). The cumulative recurrence-free survival (RFS) probability was both close to 0.0%. The median RFS time was 49.1 (95% CI 46.1 ~ 51.7) and 44.3 (95% CI 41 ~ 46.1) months. The difference in disease status was statistically significant by the Log-rank test (p < 0.05). Using the random-effects model of two-stage analysis, the minor hepatectomy subgroup (HR = 1.32, 95% CI [1.09, 1.55], I² = 6.2%, p = 0.383) and the shared fragile model of one-stage analysis (HR = 1.44 95% CI [1.23, 1.69], p < 0.001) suggested that LH could significantly prolong RFS of patients compared with OH. This result was consistent with sensitivity analysis using different models.

Conclusion

This study was the first reconstructed time-to-event data based on a high-quality propensity-score matching study to compare the survival outcomes of LH and OH in the treatment of HCC. Results suggested that LH can improve RFS in patients with HCC undergoing minor hepatectomy and may also benefit long-term RFS in overall patients.

中文翻译：

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肝细胞癌腹腔镜和开腹肝切除术的生存分析：基于重建的事件发生时间数据的荟萃分析

研究背景/目的

腹腔镜肝切除术（LH）已广泛用于治疗肝细胞癌（HCC）。人们普遍认为，LH 的长期结果并不逊于开腹肝切除术 (OH)。然而，证据的质量很低。本研究的目的是重建基于倾向评分匹配研究的 Kaplan-Meier 曲线进行荟萃分析的事件发生时间数据，并比较肝细胞癌 LH 和 OH 后的存活率。

方法

筛选了所有以英语报道的将 LH 和 OH 与 Kaplan-Meier 曲线比较肝细胞癌的倾向评分匹配研究。借助计算机视觉程序重建患者的生存信息。对敏感性分析进行了不同的模型（两阶段生存分析的固定效应模型和一阶段生存分析的 Cox 回归）。除了主要的荟萃分析外，还按切除类型、肝硬化状态对患者进行了两项特定的亚组分析。

结果

事件发生时间数据来自 45 项倾向评分匹配研究 ( N  = 8905)。根据事件发生时间数据和重建的 Kaplan-Meier 曲线，LH 和 OH 队列的累积总生存率分别为 49.0% 和 50.9%，对数秩检验未显示出统计学意义（p  > 0.05)。累积无复发生存 (RFS) 概率均接近 0.0%。中位 RFS 时间为 49.1 (95% CI 46.1 ~ 51.7) 和 44.3 (95% CI 41 ~ 46.1) 个月。通过Log-rank检验，疾病状态的差异具有统计学意义（p  <0.05）。使用两阶段分析的随机效应模型，小肝切除亚组 (HR = 1.32, 95% CI [1.09, 1.55], I ²  = 6.2%,p  = 0.383）和一期分析的共享脆弱模型（HR = 1.44 95% CI [1.23, 1.69], p  < 0.001）表明，与 OH 相比，LH 可以显着延长患者的 RFS。该结果与使用不同模型的敏感性分析一致。

结论

这项研究是第一个基于高质量倾向评分匹配研究重建的事件发生时间数据，以比较 LH 和 OH 在 HCC 治疗中的生存结果。结果表明，LH 可以改善接受小型肝切除术的 HCC 患者的 RFS，也可能有益于整体患者的长期 RFS。