单发直径5cm以内肝细胞癌行射频消融与手术切除疗效比较

Comparism of radiofrequency ablation and surgical resection in pa- tients with solitary hepatocellular carcinoma within 5 cm

目的比较单发直径≤5cm的肝细胞癌患者行射频消融术与手术切除的疗效，为临床治疗方案选择提供循证参考。方法检索2005—2012年发表的比较射频消融术与手术切除治疗直径≤5cm的单发肿瘤的对照研究，两者问肝功能无显著差异是筛选的必要条件。检索数据库包括Pubmed、EMBASE等。应用Revman5．0软件比较射频消融术与手术切除的患者1、3、5年总体及无瘤生存率。根据各研究间的异质性选择随机效应模型或者固定效应模型行Meta分析，比较射频消融术与手术切除的初始治疗效果。结果5项研究符合入组要求，共包括644例患者，其中270例接受射频消融术，374例接受手术切除。所有研究患者中射频消融术与手术切除组肝功能差异无统计学意义。Meta分析结果显示，对于单发肿瘤直径≤5em的患者，行射频消融术与手术切除的1、3、5年总体生存率差异无统计学意义（P〉0．05）。然而，手术切除患者的1、3、5年无瘤生存率优于射频消融术，差异具有统计学意义（P〈0．05）。结论对于直径≤5cm的单发肿瘤，射频消融术可取得与手术切除相当的术后生存时间，但射频消融术后局部复发率较高，无瘤生存率较手术切除低。

Objective To compare the primary treatment efficacy of radiofrequency ablation and surgical resec- tion in patients with solitary hepatocellular carcinoma （HCC） which the diameter is ≤5 cm. Methods Databases were searched for comparative studies on radiofrequency ablatiom vs surgical resection published from 2005 to 2012. A Meta-analysis was performed using a randomized or fixed effect model to compare the treatment efficacy between radiofrequency ablatiom and surgical resection. Results Five studies fulfilled the criteria and were included. For HCC patients whose single tumors＇ diameter is ≤ 5 cm, radiofrequency ablation was equivalent to surgical resection for 1-, 3- and 5- year overall survivals （ P 〉 0. 05 ）. However, surgical resection was superior to radiofrequency ab- lation in 1-, 3-and 5-year disease-free survivals and there＇ s significant difference （P 〈0.05）. Higher local recur- rence rate was associated with radiofrequency ablation than surgical resection. Conclusions For HCC patients whose single tumors＇ diameter is ≤5 cm, radiofrequency ablation can achieve comparable overall survival as surgi- cal resection, though with higher recurrence rate and lower disease-free survival.