经皮射频消融与肝切除治疗小肝癌的疗效比较meta分析

Percutaneous radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma：a meta analysis

目的利用meta分析的方法，评价经皮射频消融与手术切除治疗符合Milan标准的小肝癌的疗效。方法选取发表于1990年1月至2010年2月的文献，对比分析经皮射频消融与手术切除两种方式治疗符合Milan标准的小肝癌疗效的临床随机对照试验研究，并应用meta分析方法评价总体生存率以及术后复发率等相关指标。结果共有4篇前瞻性随机对照研究纳入此分析，包括539例患者，其中经皮射频消融治疗252例患者，手术切除治疗287例患者。经皮射频消融与手术切除治疗患者之间术后总体生存率的差异无统计学意义（p〉0．05）；经皮射频消融术治疗患者术后2、3、4年无瘤生存率均低于手术切除，差异有统计学意义（P〈0．05）。经皮射频消融术治疗患者术后肿瘤复发率高于手术切除，差异有统计学意义（OR：2．63，95％CI：1．67～4．15，P=0．000）。经皮射频消融术治疗患者术后并发症的发生率低于手术切除，差异有统计学意义（OR：0．14，95％CI：0．09～0．22，P=0．000）。结论对于符合Milan标准且适应手术切除和经皮射频消融治疗指征的小肝癌，经皮射频消融与手术切除治疗患者的术后总体生存率相似。经皮射频消融具有侵袭性小、术后并发症发生率低等优点，但是手术切除能够较好的预防术后肿瘤复发。对于不愿意行手术切除的患者，可推荐选择经皮射频消融治疗。

Objective To evaluate the curative effect of percutaneous radiofrequency ablation （RFA） and hepatic resection （ RES ） for small hepatocarcinoma eligibled for Milan criterion using meta analysis method. Methods Retrieved clinical trials comparing percutaneous radiofrequency ablation with RES for small hepatocarcinoma published from 1990 to 2010. A meta-analysis was conducted to estimate overall survival and disease free survival. A fixed random effect model or random effect model was established to collect the data~ Results Four randomized controlled trials were included in this analysis. These studies included a total of 539 patients： 252 treated with percutaneous RFA and 287 treated with RES. The differences in overall survival were not statistically significant between RFA and RES （ P 〉 0. 05 ）. In the patients treated with RES group, the 2-, 3- and 4- years disease free survival rates were significantly better than that in the patients treated with percutaneous RFA （ P 〈 0. 05 ）. The postoperative morbidity rate was significant lower in patients treated with percutaneous RFA（ OR ：0. 14,95% CI：0. 09-0. 22 ,P = 0. 000 ）. But pereutaneous RFA had a higher rate of tumor recurrence compared to RES（ OR：2. 63,95% CI： 1.67-4. 15, P = 0. 000）. Conclusions For small hepatoearcinoma eligibled for Milan criterion, percutaneous RFA had a similar overall survival to RES. Pereutaneous RFA was the invasive lesser and had a lower postoperative morbidity rate than RES, but RES may had a better prevention of the tumor recurrence than percutaneous RFA. For those patients who don＇t want to be treated by RES, percutaneous RFA may be a recommendable choice.