三维适形放疗联合TACE治疗肝癌伴门静脉癌栓的有效性与安全性的Meta分析

Meta analysis of effectiveness and safety of 3-DCRT combined with TACE in treatment of primary hepatic carcinoma with portal vein tumor thrombus

目的:系统评价三维适形放疗(three-dimensional conformal radiotherapy,3-DCRT)联合经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌(primary hepatic carcinoma,PHC)伴门静脉癌栓(portal vein tumour thrombus,PVTT)的有效性与安全性。方法:计算机检索循证医学数据库、PubMed、Embase、Web of Science、CBM、VIP、CNKI和万方数据库,检索时限为建库至2018-07。筛选出符合纳入标准的临床对照试验,提取资料数据及评价质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入15篇临床对照,其中7篇临床随机对照研究(randomized controlled trials,RCT)和8篇回顾性研究。Meta分析结果显示,3-DCRT联合TACE组治疗总有效率明显高于单纯TACE组(OR=2.44,95%CI为1.01～5.89,P<0.01);3-DCRT联合TACE组的1年累计生存率(OR=3.03,95%CI为2.34～3.91)、2年累计生存率(OR=4.34,95%CI为2.75～6.85)均明显高于单纯TACE组,差异有统计学意义(均P<0.01);治疗后白细胞减少、发热、胃肠道反应、肝功能不全等不良反应发生率比较,两组差异无统计学意义。但术后试验组放射性肝炎(OR=3.39,95%CI为1.78～8.96,P=0.0008)、消化道出血(OR=4.35,95%CI为1.21～15.67,P=0.02)的发生率高于对照组,差异有统计学意义。结论:3-DCRT联合TACE治疗PHC合并PVTT的近期、远期疗效明显优于单纯TACE治疗。但在放射性肝炎、消化道出血不良反应发生率方面,试验组高于对照组。由于纳入文献质量及数量的限制,本研究需要更高质量、多中心、大样本的前瞻性随机对照研究予以证实。

Objective:To systematically evaluate the clinical effectiveness and safety of three-dimensional conformal radiotherapy (3 -DCRT) combined with transcatheter arterial chemoembolization (TACE) in treatment of primary hepatic carcinoma (PHC) associated with portal vein tumor thrombus (PVTT).Methods:Computer retrieval of the Cochrane Library,PubMed,Embase,Web of Science,CBM,VIP,CNKI,WanFang Data and other databases were conducted to collect the clinical control study literature.The retrieval time was from the establishment of the database to March 2018.According to the inclusion and exclusion criteria,the eligible controlled trials were selected.After data and the quality was assessed,Meta analysis was performed by using RevMan 5.3software.Results:Fifteen clinical controlled trials were included,7 papers were randomized controlled trials (RCT) and 8 papers were retrospective study.Meta analysis results revealed that the total effective rate of 3-DCRT combined with TACE group was higher than that of TACE alone (OR=2.44,95%CI=1.01-5.89,P<0.01),and compared with the TACE alone,3-DCRT combined with TACE had significantly increased 1-year survival rates (OR=3.03,95%CI=2.34-3.91,P<0.01),2-year survival rates (OR=4.34,95%CI=2.75-6.85,P<0.01).There were no statistically significant differences in leukopenia,fever,gastrointestinal reactions,liver dysfunction between the two groups.Postoperative complication rates of radioactive hepatitis (OR=3.39,95%CI=1.78-8.96,P=0.0008) and gastrointestinal bleeding (OR=4.35,95%CI=1.21-15.67,P=0.02) in the experimental group were higher than those in the control group.Conclusion:The short-term and long-term curative effects of 3-DCRT combined with TACE in the treatment of PHC combined with PVTT are significantly better than those in TACE alone.However,the incidence of adverse reactions of radiation hepatitis and gastrointestinal bleeding in experimental group is higher than the control group.Due to the limited quantity and quality of the included studies,the conclusions of this study need to be confirmed by aprospective randomized controlled trial of higher quality,multicenter,large sample.