射频消融、无水乙醇注射与手术切除治疗小肝癌疗效的Meta分析

Therapeutic effects of radiofrequency ablation, percutaneous ethanol injection or surgical resection on early stage hepatocellular carcinoma： a Meta-analysis

目的比较经皮射频消融（RFA）、无水乙醇注射（PEI）与手术切除（SR）治疗小肝癌（SHCC）的临床疗效。方法检索CochraneLibrary、EMBASE、PubMed、CBM、CNKI、万方数据库和维普数据库，收集比较RFA或PEI与SR治疗SHCC效果的临床研究，应用Stata12．0软件进行Meta分析。结果共纳入18篇研究。其中14篇为RFA与SR治疗研究，共1959例患者；4篇为PEI与SR治疗研究，共12038例患者。结果显示：术后1年生存率SR与RFA和PEI比较差异无统计学意义（P〉0．05）。术后3年生存率SR优于RFA（RR3年=0．87，95％CI：0．78～0．98，P〈0．05），而SR与PEI差异无统计学意义。术后5年生存率SR优于RFA（RR5年=0．71，95％CI：0．51～0．98，P〈0．05）和PEI（RR54=0．72，95％CI：0．62—0．85，P〈0．05）。术后1年无瘤生存时间SR与PFA和PEI差异均无统计学意义。术后3年无瘤生存时间SR优于PEI（RRm=0．66，95％CI：0．44～0．97，P〈0．05），而SR与RFA差异无统计学意义。术后5年无瘤生存时间SR优于RFA（RR5年=0．63，95％C1：0．49—0．80，P〈0．05）和PEI（RR5年=0．67，95％CI：0．44～0．98，P〈0．05）。结论SR治疗SHCC的远期总体疗效明显优于RFA和PEI，而近期疗效三种方法差异不明显。SR应该成为治疗SHCC的首选方法。

Objective To study the therapeutic effects of percutaneous radiofrequency ablation （ RFA）, percutaneous ethanol injection （PEI） or surgical resection （SR） for small hepatocellular carcinoma （SHCC）. Methods The clinical data were collected from the databases of the Cochrane Collaboration, EMBASE, PubMed, CBM, China National Knowledge Infrastructure （CNKI） , Wanfang and VIP database. A Meta-analysis was conducted using Stata 12. 0 software. Results 18 RCTs （randomized controlled trials） were included into this study. Of the 14 studies which compared RFA with SR for 1 959 patients with SHCC, 1 016 patients received RFA and 943 patients received SR, respectively. Of the 4 studies which compared PEI with SR （ n = 12 038 ）, 3 652 patients received PEI while 8 386 patients received SR. There were no sig- nificant differences in the post treatment 1-year overall survival rates （OS） among the SR, PEI and RFA groups. The 3-year OS was better in the SR group than the RFA group （ RR 3 years = 0. 87 ,95% CI： 0. 78 - 0. 98, Z = 2.40,P 〈 0. 05 ）, while there was no significant difference between the RFA and PEI groups. The 5 year OS was significantly better in the SR group than the RFA group （ RR 5 years =0. 71 ,95% CI：0. 51 - 0. 98, P 〈 0. 05 ） and the PEI group （ RR 5 years = 0. 72 ,95% CI：0. 62 - 0. 85, P 〈 0. 05 ）. There were no significant differences in the 1-year tumor-free survival rates among the SR, RFA and PEI groups. The SR group was significantly better than the PEI group in the 3-year tumor-free survival rate （ RR 3 years = 0. 66, 95 % C1：0.44 -0. 97, P 〈 0. 05 ）, while there was no significant difference between the SR and RFA groups. The 5-year tumor-free survival rate in the SR group was significantly better than the RFA group （ RR s years = 0. 63,95 % CI：0. 49 - 0. 80, Z = 3.81, P 〈 0. 001 ） and the PEI group （ RR 5 yeors = 0. 67,95 % CI：0. 44 - 0. 98, P 〈 0. 05 ）. Conclusions The overall therapeutic effect of SR was better than RFA or PEI, in particular in the post-treatment overall survival rates and tumor-free survival rates. SR should be considered as the first choice of treatment for SHCC.