| Aims:Primary liver cancer is the second leading cause of cancer-related death in China.More than 90% of primary liver cancers are hepatocellular carcinoma（HCC）,and the life expectancy after diagnosis of HCC is lower than that of many other cancers.One factor contributing to this poor prognosis is the biological nature of the liver cancer itself,and the other is that most patients with liver cancer are diagnosed at an advanced stage,when the opportunity for radical resection has been lost.Therefore,systemic therapy is the standard treatment for most patients with liver cancer.However,the overall survival（OS）of patients with liver cancer receiving systematic treatment is very low.In recent years,many new treatments have shown effectiveness in the treatment of HCC in terms of tumor response and patient survival.The aim of neoadjuvant therapy is to reduce tumor size before surgical treatment,to achieve tumor reduction,and to provide the opportunity of surgical resection for patients with malignant tumors,to reduce postoperative recurrence and to prolong postoperative survival.The purpose of this study is to systematically evaluate of neoadjuvant therapy in improving the therapeutic effect of hepatocellular carcinoma through the method of evidence-based medicine.Methods:We searched Chinese and foreign databases such as Pubmed,Cochrane Library,Embase,CNKI,VIP database,Wanfang database,etc.We searched for studies related to evaluation of neoadjuvant therapy in improving the therapeutic effect of hepatocellular carcinoma by using the strategy of using subject headings combined with free words.At the same time,we browsed the bibliography of relevant reviews and manually searched for studies that might be missed.The final inclusion literature was determined according to the inclusion criteria and exclusion criteria,the basic information and diagnostic test data of the included studies were extracted,and evaluation of neoadjuvant therapy in improving the therapeutic effect of hepatocellular carcinoma was analyzed by Meta-analysis with the help of statistical software such as STATA 15.1 and Revman 5.3.Results:Finally,23 articles were included,and the total number of patients included in the study was 5482,as shown by Meta-analysis.Patients with unresectable hepatocellular carcinoma who underwent salvage resections after reduced conversion therapy had 1-year survival（RR : 2.07,95%CI : 1.89-2.26）and 3-year survival（RR:3.92,95% CI:2.93-5.24）and 5-year survival（RR:4.57,95%CI:2.86-7.30）were superior to patients without salvage resection.In addition,patients with unresectable liver cancer who chose systemic therapy for conversion therapy were superior to those who chose 1-year survival rate（local therapy group RR :1.69,95%CI:1.34-2.14,systemic therapy group RR:2.26,95%CI:1.96-2.61,comparison between the two groups RR:1.90,95%CI:1.59-2.27）,3-year survival rate（local therapy group RR : 3.17,95%CI : 2.20-4.57,systemic therapy group RR:7.93,95%CI:3.93-16.00,comparison between the two groups RR:3.92,95%CI : 2.66-5.79）and 5-year survival rate（local therapy group RR : 4.41,95%CI : 2.07-9.42,systemic therapy group RR : 5.57,95%CI : 1.08-28.67,comparison between the two groups RR:4.57,95%CI:2.35-8.90）.Preoperative neoadjuvant therapy for patients with resectable liver cancer had 1-year survival（RR :1.24,95%CI:1.05-1.47）,3-year survival（RR: 1.35,95%CI:1.20-1.53）,5-year survival（RR : 1.47,95%CI : 1.25-1.72）,and 1-year disease-free survival（RR :1.47,95%CI:1.29-1.68）,3-year disease-free survival（RR:1.27,95%CI: 1.09-1.48）is superior to the surgical resection group alone.In terms of 5-year disease-free survival,there was no significant difference between preoperative neoadjuvant therapy and surgical resection alone in patients with resectable liver cancer（RR :1.10,95% CI : 0.99-1.22）.Surgical resection after neoadjuvant therapy for unresectable liver cancer is superior to resectable liver cancer patients in terms of 1-year survival（RR: 1.58,95%CI: 1.33-1.88）,3-year survival（RR: 2.54,95%CI :1.83-3.52）,and 5-year survival（RR:2.21,95CI:1.63-3.00）.Conclusions:1,3,and 5-year survival rate of patients with unresectable liver cancer who underwent surgical resection after neoadjuvant treatment was lower than that of patients without surgical resection.The neoadjuvant treatment option with systemic therapy is superior to that of patients with unresectable liver cancer in terms of 1-,3-and 5-year survival rates.Neoadjuvant therapy was superior to surgical resection alone in 1-,3-,5-year survival and 1-,3-year disease-free survival.There was no significant difference in 5-year disease-free survival between preoperative neoadjuvant therapy and surgical resection alone in patients with resectable liver cancer.The 1-year,3-year,and 5-year survival rates of patients with unresectable hepatocellular carcinoma after neoadjuvant therapy are better than those of patients with resectable hepatocellular carcinoma. |
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