TACE联合PSE治疗HCC合并脾亢患者的疗效和安全性的Meta分析

Efficacy and Safety of TACE Combined with PSE for HCC Patients with Hypersplenism:A Meta-analysis

目的系统评价TACE联合PSE治疗原发性肝癌伴脾功能亢进患者的疗效及安全性。方法计算机检索The Cochrane Library(2015年11期)、PubMed、EMbase、CBM、VIP、CNKI和WanFang Data数据库,检索时限均从建库至2015年11月,搜集TACE联合PSE治疗原发性肝癌的相关随机对照试验(RCT)。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括708例患者。Meta分析结果显示:TACE联合PSE较单纯TACE能明显提升晚期HCC合并脾亢患者术后4周CD4计数[MD=6.99,95%CI(4.60,9.38),P<0.000 01]、CD4/CD8比值[MD=0.64,95%(0.45,0.84),P<0.000 01]和半年生存率[RR=1.16,95%CI(1.02,1.32),P=0.02],降低自发性腹膜炎[RR=0.20,95%CI(0.05,0.84),P=0.03]和食道胃底静脉破裂出血的发生率[RR=0.17,95%CI(0.04,0.68),P=0.01]。两组术后栓塞综合征发生率相当[RR=1.17,95%CI(0.79,1.75),P=0.44]。结论在不能手术切除的中晚期原发性肝癌合并脾亢患者中,TACE联合PSE较单纯TACE治疗更安全有效。受纳入的研究数量和质量的限制,上述结论仍有待开展更多高质量研究予以证实。

Objective To systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with partial splenic embolization （PSE） for hepatocellular carcinoma （HCC） with hypersplenism. Method We searched The Cochrane Library （Issue 11, 2015）, PubMed, EMbase, CBM, VIP, CNKI and WanFang Data databases from inception to November 1s＇ 2015, to collect randomized controlled trials （RCTs） about TACE combined with PSE in treating HCC with hypersplenism. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs involving 708 patients were included. The results of meta-analysis showed that： Compared with TACE alone, TACE combined with PSE could significantly improve postoperative CD4 count （MD=6.99, 95%CI 4.60 to 9.38, P〈0.000 01）, CD4/CD8 ratio （MD=0.64, 95% 0.45 to 0.84, P〈0.000 01）, and the rate of half year survival （RR=I.16, 95%CI 1.02 to 1.32, P=0.02）, decrease the incidences of spontaneous peritonitis （RR=0.20, 95%CI 0.05 to 0.48, P=0.03） and varices bleeding （RR= 0.17, 95%CI 0.04 to 0.68, P=0.01） The two groups had similar incidence of post-embolization syndrome （RR=1.17, 95%CI 0.79 to 1.75, P=0.44）. Conclusion TACE combined with PSE is more safe and effective than TACE alone in unresectable HCC with hypersplenism. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale RCTs.