手术切除治疗胰腺神经内分泌肿瘤肝转移的Meta分析

Liver resection for patients with liver metastasis of pancreatic neuroendocrine tumors： a meta-analysis

目的 探讨手术切除治疗胰腺神经内分泌肿瘤（pancreatic neuroendocrine tumors,PNETs）肝转移的价值.方法 搜索截至2012年8月的CNKI、CBM、MEDLINE、The Cochrane Library、EMBASE的相关随机研究.收录并比较单纯手术切除术和非手术治疗（射频消融、化疗、肝动脉栓塞及药物等）的随机临床研究（不受语言、盲法及发表状况限制）.由2位评价者依据检索策略收集资料,按纳入标准筛选文献.主要观察围手术期（30 d）的死亡率、症状缓解率及术后生存率指标.使用RevMan 5.1软件进行Meta分析.结果 目前无手术治疗PNETs肝转移临床效果的Meta-anlaysis、临床随机对照实验（randomized controlled trial,RCT）、非完全随机研究（quasi-randomised controlled trial,QRCT）文献.查得6篇回顾性队列研究（retrospective cohort study,RCS）纳入,涉及1020例.单纯手术切除术与肝动脉栓塞术（hepatic artery embolization,HAE）、经动脉治疗（intra-arterialtherapy,ITA）、药物（奥曲肽）、全身化疗等非手术治疗PNETs相比较,3年生存率[OR =0.24,95％CI（0.11,0.53）,P=o.0004]及5年生存率[OR =0.16,95％CI （0.12,0.22）,P＜0.00001]显著升高,中位生存期明显延长[（109.5±19.02）vs（31.2±5.97）个月,P＜ 0.01],差异有统计学意义.手术组症状缓解率显著高于非手术组[（98.3±2.8）vs（62.5±22.0）,P＜ 0.05],差异有统计学意义.手术组的围手术期死亡率低.结论 手术切除术是治疗PNETs肝转移首选的治疗方法.手术切除治疗安全有效,生存期明显延长,症状缓解率明显提高.由于目前缺乏RCT,手术切除治疗PNETs肝转移有效的证据需进一步的随机对照研究.

Objective To explore the potential benefits of liver resection for patients with liver metastasis of pancreatic neuroendocrine tumors（PNETs）.Methods We searched CNKI,CBM,MEDLINE,The Cochrane Library,EMBASE until Aug.2012 for identifying randomized trials.Randomized clinical trials（irrespective of language,blinding,or publication status）were collected to compare liver resection alone versus other unresected interventions（radiofrequency ablation,chemotherapy,hepatic arterial embolization,or drugs et al）in patients with liver metastasis from PNETs.Two authors independently identified trials for inclusion.The primary outcome was survival,treatment-related mortality（30-day mortality）and relief of symptoms.RevMan 5.1 software was used for Meta analysis.Results There was no meta-anlaysis,RCT,QRCT showing the clinical effect of operation for the treatment of pancreatic neuroendocrine tumor with liver metastasis.Only 6 cohort studies found were eligible and analyzed,involving 1020 patients.Compared with unresected treatment,the 3-year survival rate[OR =0.24,95％ CI （0.11,0.53）,P =0.0004],the 5-year survival rate [OR =0.16,95 ％ CI （0.12,0.22）,P ＜ 0.00001] and median survival time （109.5 ± 19.02 vs 31.2 ± 5.97 months,P ＜ 0.01） were significantly increased in liver resection alone.The symptom relief rate was substantially higher in the surgical group than in the non-surgical group（98.3 ±2.8 vs 62.5 ± 22.0,P ＜ 0.05）.Perioperative mortality rate was lower in surgical group.Conclusions Surgical resection is the preferred treatment of PNETs in patients with liver metastasis.Surgery is safe and effective.Survival time is significantly extended and symptom relief rate significantly improves.Due to lack of randomized controlled trial （RCT）,surgical resection for treatment of liver metastasis of PNETs requires further more randomized control study.