Ⅰ～Ⅲ期结直肠癌患者围手术期肝脏局部化疗对术后肝转移及生存率影响的Meta分析

Meta-analysis: perioperative regional liver chemotherapy for the survival and prevention of liver metastases in patients with colorectal carcinoma

背景与目的:结直肠癌发病率逐年上升,手术切除是其主要治疗方式,但术后肝转移普遍存在,而全身化疗对肝转移预防作用有限,故不断有研究者探讨肝脏局部化疗对肝转移及生存率的影响。本研究旨在评价预防性肝脏局部化疗对结直肠癌患者术后生存率和肝转移的影响。方法:检索1990年1月—2009年12月MEDLINE和EMBASE数据库中所有相关文章。依据治疗方法的不同分为2个亚组:门静脉灌注化疗组和肝动脉灌注化疗组,分别分析其5年生存率和肝转移率。分析软件为RevMan5.0.23。结果:9项临床试验共3513例患者纳入本研究(其中门静脉组7项,肝动脉组2项)。Meta分析结果显示,肝动脉灌注化疗组术后5年总死亡率相对危险度为0.46(95%CI为0.31～0.69),肝转移率相对危险度为0.44(95%CI为0.28～0.68);门静脉灌注化疗组术后5年总死亡率相对危险度为0.98(95%CI为0.89～1.09),肝转移率相对危险度为0.86(95%CI为0.72～1.02)。结论:在肝脏局部化疗方法中,肝动脉灌注化疗能显著降低结直肠癌患者术后死亡率及肝转移率,而门静脉灌注化疗作用不明显。

Background and purpose：The morbility of CRC has increased gradually in recent years. The primary modality of treatment is surgery, but liver tumor metastases is still a big problem. Systemic chemotherapy has no apparent effect on the prevention of liver tumor recurrence in CRC. Hence, a continuous infusion of cytotoxic drugs into the liver via the portal vein or hepatic artery during the perioperative period has been proposed to reduce liver metastases after surgery. This study evaluated the effects of prophylactic regional liver chemotherapy during the perioperative period on survival and prevention of liver metastases in the patients with colorectal cancer （CRC）. Methods：A comprehensive search of relevant databases, including MEDLINE, EMBASE was conducted. Trials were divided into two subgroups according to therapy type. The rates of mortality and liver metastases were analyzed using a fixed-effects model. A statistical analysis was performed with Review Manager’s software （RevMan 5.0.23）. Results：Meta-analysis results showed statistically significant differences in terms of survival in patients receiving perioperative hepatic artery infusion （HAI） chemotherapy in comparison to patients receiving surgery alone （pooled relative risk P=0.46, 95% CI： 0.31-0.69）. Liver metastases rate also displayed a statistically significant difference （pooled relative risk P=0.44, 95% CI： 0.28-0.68）. There were no statistically significant differences in terms of survival and liver metastases rate in the patients receiving perioperative portal vein infusion （PVI） chemotherapy in comparison to the patients receiving surgery alone （pooled relative risk P=0.98, 95% CI： 0.89-1.09; pooled relative risk P=0.86, 95% CI： 0.72-1.02, respectively）. Conclusion：As one of the methods of regional liver chemotherapy, HAI may be able to reduce liver metastases in patients with advanced CRC.