姑息化疗对晚期肝癌疗效的Meta分析

Meta Analysis of Chemotherapy with Best Supportive Care in the Survival of Inoperable Hepatocellular Carcinoma

目的:评价阿霉素等传统化疗药物是否能使晚期肝癌患者的总生存率得到获益。方法:使用系统评价方法。检索MEDLINE、EMBASE等国内外数据库中的相关文献,选择治疗组为姑息化疗并对症支持治疗,对照组只给予对症支持治疗(包括部分非细胞毒性药物)的晚期肝癌的随机对照试验(RCT)。由2位评价者分别按以上检索策略收集资料,按选择标准入选,主要对半年生存率及一年生存率进行Meta分析。结果:姑息化疗与最佳支持治疗对比,姑息化疗不能提高半年和一年生存率,差异无统计学意义。结论:目前姑息化疗不推荐用于晚期肝癌,需要开展一系列大规模的随机对照临床试验以解决这一争议。

Objective：To evaluate the effects of chemotherapy on survival of patients with inoperable hepatocellular carcinoma. Methods：MEDLINE and EMBASE searches were supplemented by information from trial registers. RCT （randomized clinical trial） for chemotherapy of old generation and best supportive care in inoperable hepatocellular carcinoma was selected. Best supportive care may include some non-cytotoxic drug,such as tamoxifen,octreotide and so on. A quantitative meta-analysis using updated information basing on inclusion and exclusion criterion from all available RCT was carried out by two reviewers. The meta-analysis was based on 6 months survival rate and 1 year survival rate. Result：There was no significant improvement for chemotherapy of old generation in 6 months survival rate and 1 year survival rate as compared with best supportive care. Conclusions：There is no convincing evidence that inoperable hepatocellular carcinoma patients will benefit from chemotherapy. A large number of randomized controlled clinical studies should be performed to confirm the efficacy of chemotherapy.