经皮射频消融与无水乙醇注射治疗合并肝硬化的小肝癌疗效比较的Meta分析

Comparison between RFA with PEI in the treatment of small HCC in cirrhosis:a meta-analysis

目的评价经皮射频消融（RFA）与经皮无水乙醇注射（PEI）治疗合并肝硬化的小肝癌（SHCC）的疗效。方法计算机检索PubMed数据库（1966~）,EMBASE（1989~）,中国生物医学文献数据库（1980~）和Cochrane2008图书馆临床对照试验资料库,检索截止日期为2009年6月。纳入比较RFA与PEI治疗合并肝硬化的SHCC疗效的文献并进行质量评价,应用Sta-ta9.0软件对肿瘤坏死率、1年和3年局部复发率进行统计分析,应用Hazard Ratio工作表计算生存率曲线中的死亡危险比。结果共纳入5项RCT,包括754例合并肝硬化的SHCC（其中RFA组354例,PEI组400例）。Meta分析结果显示,RFA较PEI能提高对单个直径小于或等于5 cm或肿瘤数目1~3个且直径小于3 cm的合并肝硬化的SHCC坏死率（P〈0.001）、降低死亡风险（P=0.001）、并减少1年（P=0.004）和3年局部复发率（P=0.001）。结论 RFA治疗单个直径小于或等于5 cm或肿瘤数目1~3个且直径小于3 cm的合并肝硬化的SHCC总体疗效优于PEI。

Objective To evaluate the effect of radio frequency ablation（RFA） in the treatment of small hepatocellular carcinoma（HCC）（≤5cm in diameter and/or 1-3HCCs） in Cirrhosis patients when comparing with percutaneous ethanol injection（PEI）.Methods We searched PubMed（1966-2008）,Cochrane Library2008,EMBASE databases（1989-2008） and Chinese Biomedicine databases（1980-2008）.We selected the randomized clinical trials evaluating RFA vs.PEI and their data.Outcomes were overall survival or death Hazard ratio,local recurrence and complete tumour necrosis.Meta-analysis software was used odds ratio（OR）and Hazard ratio（HR） or Relative risk（RR） and their 95% confidence intervals and Q-test for heterogeneity were calculated.Results Five Prospective RCTs were identified including 754 patients（354 in RFA group,400 in PEI group）.The complete tumour necrosis was significantly higher in patients treated with RFA than in those treated with PEI（P0.001）.The death Hazard ratio was significantly lower in patients treated with RFA than in those treated with PEI（P=0.001）.The 1 and 3 years local recurrence rate is significantly lower in patients treated with RFA than in those treated with PEI（P=0.004,P=0.001）.Conclusion RFA is superior to PEI in the treatment of small HCC in Cirrhosis with respect to overall survival and tumor response.RFA shows a significantly smaller risk of death Hazard and local recurrence.