射频消融治疗与经皮无水酒精注射对小肝癌治疗疗效比较的系统评价

Comparison between RFA with PEI in the Treatment of Small HCC: A Systematic Review

目的评价射频消融治疗是否比经皮无水酒精注射治疗小肝癌具有更好的疗效。方法计算机检索MEDLINE(1966-2005年)、EMBASE(1989-2005年)、Cochrane图书馆临床对照试验资料库(2005年第1期)、互联网上注册临床试验数据库、中国生物医学文献数据库(1980-2005年),文献语种不限。纳入比较射频消融治疗和经皮无水酒精注射治疗小肝癌的随机对照试验,对纳入研究的方法学及质量进行评价,并应用RevMan4.2软件进行统计分析。结果共纳入4个随机对照试验。Meta分析结果表明,射频消融治疗较经皮无水酒精注射能提高对>2cm小肝癌的3年生存率、1年和3年无瘤生存率并减少1年和3年局部复发率;而对直径≤2cm的小肝癌,射频消融治疗与经皮无水酒精注射治疗效果相似,无显著差异。结论射频消融治疗小肝癌的总体疗效优于经皮无水酒精注射治疗,尤其对于肿瘤直径>2cm的小肝癌;且两种方法副作用均小,安全可靠。上述结论对于指导临床治疗小肝癌的方法选择具有很好的意义。

Objective To evaluate the effectiveness of radio-frequency thermal ablation （RFA） in the treatment of small hepatocellular carcinoma （HCC） in patients with cirrhosis when compared with percutaneous ethanol injection （PEI）. Methods We searched MEDLINE （1966-2005）, EMBASE （1989-2005） ,The Cochrane Library （Issue 1, 2005）, www. controlled-trials.corn, and Chinese Biomedicine Database（1980-2005）. The quality evaluation of studies and the data analysis followed the methods of The Cochrane Collaboration. Meta-analysis was performed by RevMan 4.2 software. Results Four randomized controlled studies met the inclusion criteria. The results of meta-ananlysis show that the 1,3-year overall survival rate and 1,3-year tumor-free survival rate were significantly higher, and the 1,3-year local recurrent rate was significantly lower in patients with small HCC 〉 2 era. But there was no significant difference in the treatment of small HCC ≤ 2 era. Conclusions The results show that RFA ablation yielded better clinical outcomes than PEI in treating small HCC 〉 2 cm and no difference in treating small HCC 2 cm or less.