手术切除与射频消融治疗直径3～5 cm 的原发性肝癌疗效 meta 分析

Surgical resection versus radiofrequency ablation for primary hepatocellular carcinoma of 3-5 cm in diameter:a meta-analysis

目的：系统评价外科手术与射频消融治疗直径3～5 cm的原发性肝癌的疗效。方法：计算机检索PubMed、中国生物医学文献数据库、中国知网、万方数据和维普数据库，收集关于射频消融与手术切除术治疗直径3～5 cm的原发性肝癌的临床对照研究文献，检索时限为1990年1月—2014年2月。由2位研究者根据纳入标准独立筛选文献、提取资料并评价质量后，采用 RevMan 5.0软件进行meta分析。结果：共纳入11个研究，包括1个随机对照试验和10个非随机对照试验。所纳入的研究共包含811例患者：其中直接采用射频消融术治疗的患者404例、外科手术切除的患者407例。 Meta分析表明：对于单个直径3～5 cm的原发性肝癌，手术组3、5年无瘤生存率高于射频消融组，差异有统计学意义（均 P ＜0.05），两者1、3、5年累积生存率及1年无瘤生存率差异无统计学意义（均P＞0.05）；对于1或2个直径均为3～5 cm的原发性肝癌，手术组的5年累积生存率及3、5年无瘤生存率高于射频消融组，差异有统计学意义（均P＜0.05），两者1、3年累积生存率及1年无瘤生存率差异无统计学意义（均P ＞0.05）；对于最大径为3～5 cm的多发性原发性肝癌，手术组的3年累积生存率高于射频消融组，差异有统计学意义（P ＜0.05），而两者1、5年累积生存率差异无统计学意义（均P ＞0.05）。结论：现有研究证据表明，对于直径3～5 cm的原发性肝癌，外科手术切除总体疗效优于射频消融治疗。受纳入研究质量和数量限制，上述结论尚需开展更多高质量研究加以验证。

Objective： To compare the therapeutic effects of surgical hepatic resection （ HR ） and radiofrequency ablation （ RFA ） in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter.Methods： The databases PubMed, CBMdisc, CNKI, WanFang Data and VIP databases were searched for controlled clinical trials on evaluating the efficacy between RFA and HR in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter published from January 1990 to February 2014.Two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the studies included.Then the meta-analysis was performed by using RevMan5.0 software.Results：Eleven controlled clinical trials were included, including one randomized controlled trial and 10 non-randomized controlled trials.A total of 811 patients were involved：404 patients were treated with RFA as the initial treatment and 407 patients with surgical resection.Meta-analysis showed that for a single lesion with diameter of 3-5 cm of primary hepatocellular carcinoma, the 3-, 5-year disease-free survival rates in HR group was significantly higher than those in RFA group （ all P0.05 ） .For 1-2 nodules with diameters of 3-5 cm of primary hepatocellular carcinoma, the 3-, 5-year disease-free survival rates and 5-year overall survival rates in HR group was significantly higher than those in RFA group （ all P0.05 ） . For maximum nodule of 3-5 cm of multiple primary hepatocellular carcinoma, the 5-year overall survival rates in HR group was significantly higher than that in RFA group （ all P0.05 ） . Conclusion： For primary hepatocellular carcinoma of 3-5 cm in diameter, HR is better than RFA.For the limitation of quality and quantity of included studies, this conclusion needs to be confirmed by more high quality studies.