肝动脉化疗栓塞术联合氩氦刀治疗肝癌疗效及安全性的系统评价

Effectiveness and Safety of TACE Combined with AHCS for Primary Hepatic Carcinomas: A Systematic Review

目的系统评价肝动脉化疗栓塞术(TACE)联合氩氦刀(AHCS)治疗原发性肝癌的疗效及安全性,为临床实践与研究提供参考。方法计算机检索e Cochrane Library、PubMed、EMbase、Web of Science、CBM、CNKI、VIP和WanFang Data等数据库,同时辅以其他检索,收集所有TACE联合氩氦刀治疗原发性肝癌的随机对照试验(RCT),检索时限均从建库至2012年5月1日。由2名评价员按照纳入标准筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入16个RCT,1 467例患者。Meta分析结果显示:①TACE+AHCS组的总有效率、完全坏死率、0.5年、1年、1.5年、2年、2.5年生存率、AFP、CD4和/Ts细胞方面均明显优于TACE组,两组差异均有统计学意义(P<0.05);②TACE+AHCS组的0.5年、1.5年、2年、2.5年生存率、AFP和细胞方面均优于AHCS组,两组差异均有统计学意义(P<0.05)。结论与单纯TACE或单纯AHCS治疗相比,TACE+AHCS治疗原发性肝癌能提高患者远期生存率和近期疗效,提高患者的免疫机能,但其长期疗效和安全性评价尚需更多大样本高质量的RCT进一步验证。

Objective To evaluate the clinical effectiveness and safety of transcatheter arterial chemoembolization （TACE） combined with argon-helium cryotherapy system （AHCS） for primary hepatic carcinomas （PHC）, and to provide references for clinical practice and research. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were searched, and other sources like the relavant references were also retrieved to collect the randomized controlled trials （RCTs） about TACE combiend with AHCS for PHC published by May ist, 2012. After literature screening, data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria, the meta-analysis was conducted using RevMan 5.1 software. Results A total of 16 RCTs involving 1 467 patients were included. The results of meta-analysis showed： a） The TACE＋AHCS group was superior to the TACE alone group in total effective rate, complete necrosis rate, 0.5-, 1-, 1.5-, 2- and 2.5-year survival rates, AFP, CD4 and Th/Ts cells, and there were significant differences （P〈0.05）; and b） The TACE＋AHCS group was superior to the AHCS alone group in 0.5-, 1.5-, 2- and 2.5-year survival rates, AFP and Th/Ts cells, and there were significant dif- ferences （P〈0.05）. Conclusion Compared with the TACE or AHCS alone, TACE combined with AHCS can improve long-term survival rate and short-term curative effect, and improve PHC patients＇ immunity. However, its long-term cu- rative effect and safety still needs to be further verified by more large sample and high quality RCTs.