复发性肝细胞癌再次手术切除与射频消融临床疗效比较的Meta分析

Comparison of clinical efficacy between surgical re-resection and radiofrequency ablation for recurrent hepatocellular carcinoma: a Meta-analysis

目的探讨再次手术切除(SRR)与射频消融(RFA)治疗复发性肝细胞癌(肝癌)的临床疗效差别。方法计算机检索2010年1月至2016年1月Medline、Pub Med、Cochrane、CNKI、CBM、万方、维普等数据库。英文检索词:hepatocellular carcinoma、hepatic carcinoma、liver cancer、liver neoplasms、HCC、recurrent、recurrence、relapse、recurring、resection、hepatectomy、radio frequency ablation、ablation、radio frequency、radio-frequency、RFA、PRFA。中文检索词:肝癌、肝细胞癌、肝肿瘤、复发、手术、射频消融。将患者分为SRR组和RFA组,对两组术后3年生存率、3年无瘤生存率、3年复发率、并发症发生率、住院时间等结局指标进行Meta分析。结果共有8篇文献,856例患者纳入本研究。其中随机对照实验1篇,回顾性分析文献7篇。Meta分析结果显示,两组3年生存率差异无统计学意义(OR=1.02,95%CI:0.75~1.39;P>0.05)。SSR组3年无瘤生存率优于RFA组(OR=1.63,95%CI:1.05~2.54;P<0.05)。两组3年复发率差异无统计学意义(OR=0.85,95%CI:0.48~1.49;P>0.05)。SRR组术后ClavienⅡ级以上并发症发生率明显高于RFA组(OR=13.33,95%CI:2.43~73.06;P<0.05)。SRR组住院时间明显长于RFA组(SMD=5.23,95%CI:2.85~7.61;P<0.05)。结论对于复发性肝癌的治疗,两种治疗方法的总体生存率无明显差异,但SRR治疗的无瘤生存率优于RFA。RFA具有临床安全性相对较高、住院时间较短等优势。

Objective To compare the difference of clinical effcacy between surgical re-resection （SRR） and radiofrequency ablation （RFA） for recurrent hepatocellular carcinoma （HCC）. Methods Literature from the databases Medline, PubMed, Cochrane, CNKI, CBM, Wangfang and VIP between January 2010 and January 2016 was searched. The English keywords were hepatocellular carcinoma, hepatic carcinoma, liver cancer, liver neoplasms, HCC, recurrent, recurrence, relapse, recurring, resection, hepatectomy, radio frequency ablation, ablation, radio frequency, radio-frequency, RFA and PRFA. And the Chinese keywords were liver cancer, hepatocellular carcinoma, liver neoplasms, recurrence, surgery and RFA. The patients were divided into the SRR group and RFA group. The outcome indicators including the 3-year survival rate, 3-year tumor-free survival rate, 3-year recurrence rate, incidence of complications and length of hospital stay after surgery of two groups were analyzed using Meta-analysis. Results A total of 8 literatures, 856 patients were included in this study, including 1 randomized controlled trial and 7 retrospective studies. The Meta-analysis results revealed that no signifcant difference was observed in the 3-year survival rate between two groups （OR=1.02, 95%CI： 0.75-1.39, P〉0.05）. The 3-year tumor-free survival rate in the SSR group was significantly higher than that in the RFA group （OR=1.63, 95%CI： 1.05-2.54, P〈0.05）. No significant difference was observed in the 3-year recurrence rate between two groups （OR=0.85, 95%CI： 0.48-1.49, P〉0.05）. The incidence of complications above Clavien grade Ⅱ after surgery in the SRR group was signifcantly higher than that in the RFA group （OR=13.33, 95%CI： 2.43-73.06, P〈0.05）. The length of hospital stay in the SRR group was signifcantly longer than that in the RFA group （SMD=5.23, 95%CI： 2.85-7.61, P〈0.05）. Conclusions For the treatment of recurrent HCC, there is no significant difference in the overall survival rate between SRR and RFA, but the tumor-free survival rate in the SRR group is signifcantly higher than that in the RFA group, whereas RFA has the advantages of higher safety and shorter length of hospital stay.