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Tác động của các biến chứng sau phẫu thuật đến sự sống sót lâu dài sau khi cắt bỏ khối u gan tế bào: Một tổng quan có hệ thống và phân tích tổng hợp
Tóm tắt
Có nhiều tranh cãi xoay quanh mối quan hệ giữa các biến chứng sau phẫu thuật (POCs) và sự sống sót lâu dài ở bệnh nhân ung thư gan tế bào (HCC) sau phẫu thuật cắt gan. Nghiên cứu này nhằm đánh giá tác động của POCs đối với tỷ lệ sống toàn bộ (OS) và tỷ lệ sống không bệnh (DFS) của HCC sau khi cắt gan. Các cơ sở dữ liệu PubMed, EMBASE và Thư viện Cochrane đã được sử dụng để tìm kiếm các nghiên cứu đủ tiêu chuẩn được công bố cho đến ngày 18 tháng 4 năm 2020, và các nghiên cứu so sánh kết quả dài hạn giữa bệnh nhân HCC có và không có POCs sau phẫu thuật cắt gan đã được đưa vào. Một mô hình ngẫu nhiên đã được sử dụng để tính toán tỷ lệ nguy cơ gộp (HR) với khoảng tin cậy 95% (CI). Phân tích nhóm và hồi quy tổng hợp đã được thực hiện để đánh giá ảnh hưởng tiềm năng của các yếu tố liên quan đến nghiên cứu, bệnh nhân và khối u đến mối quan hệ giữa POCs và kết quả ung thư, đồng thời điều chỉnh ảnh hưởng của chúng. Nghiên cứu này đã được đăng ký tại Đăng ký Quốc tế Về Các Đánh giá Hệ thống (CRD42019136109). Ba mươi bảy nghiên cứu, bao gồm 14.096 bệnh nhân, đã được coi là đủ tiêu chuẩn và bao gồm trong nghiên cứu này. So với những bệnh nhân không có POCs, những bệnh nhân phát triển POCs có tỷ lệ giảm OS đáng kể (HR 1.39, 95% CI 1.28–1.50, P < 0.001; khoảng dự đoán 1.04–1.85) và có xu hướng có DFS xấu hơn (HR 1.25, 95% CI 1.16–1.35, P < 0.001; khoảng dự đoán 0.98–1.60). Các biểu đồ phễu được cải thiện độ cong cho thấy có nguy cơ thiên lệch xuất bản. Phân tích nhóm và hồi quy tổng hợp cho thấy rằng POCs vẫn là một mối đe dọa đối với OS và DFS bất kể ảnh hưởng của các yếu tố lâm sàng-bệnh lý. Nghiên cứu này đã chứng minh rằng POCs có tác động tiêu cực đến OS và DFS ở bệnh nhân HCC sau phẫu thuật cắt gan.
Từ khóa
#biến chứng sau phẫu thuật #ung thư gan tế bào #sống sót #cắt gan #phân tích tổng hợpTài liệu tham khảo
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