肝动脉化疗栓塞联合经皮消融治疗肝细胞癌疗效的meta分析

Transcatheter arterial chemoembolization in combination with percutaneous ablation therapy for the treatment of hepatocellular carcinoma: a meta-analysis

目的综合分析肝动脉化疗栓塞(TACE)联合经皮消融(PA)与单独行TACE治疗不可手术切除的肝细胞癌(HCC)生存率、肿瘤缩小率的差异,为HCC的治疗提供理论依据。方法收集比较TACE联合PA与单独行TACE治疗不可手术切除的HCC患者生存率差异的随机对照试验(RCT),从中提取相关数据,按照Cochrane手册标准对纳入文献进行质量评价。结果共纳入15篇RCT,859例患者。meta分析显示:TACE联合PA组1、2、3年生存率、肿瘤缩小率均优于TACE单独治疗组[1年生存率:RR=1.454,95%CI(1.333,1.586),Z=8.56,P<0.001;2年生存率:RR=1.781,95%CI(1.511,2.099),Z=6.88,P<0.001;3年生存率:RR=2.351,95%CI(1.808,3.059),Z=6.37,P<0.001;肿瘤缩小率:RR=1.314,95%CI(1.190,1.452),Z=5.38,P<0.001]。敏感性分析揭示两组生存率、肿瘤缩小率的差异结果可靠。结论与单独行TACE相比,TACE联合治疗组的患者1、2、3年生存率、肿瘤缩小率均较高。

Objective To compare the differences in the long-term survival rate and the tumor shrinkage rate of inoperable hepatocellular carcinoma （HCC） between transcatheter arterial ehemoembolization （TACE） combined with percutaneous ablation therapy and simple TACE therapy in order to provide the basis for the clinical treatment of HCC. Methods Randomized controlled trials （RCT） for comparing the difference in survival rates between TACE plus PA and simple TACE for inoperable HCC were searched from medical literature database, from which the relevant data were extracted. According to Cochrane manual standard, the quality of inclusion literature was evaluated. Results A total of 15 RCT papers were included in this study, including 859 HCC patients. The results of meta- analysis showed that all the 1 -year, 2-year and 3- year survival rates in TACE plus PA group were better than those in simple TACE group （RR=1.454, 95%CI=1.333 and 1.586, Z=8.56, P〈0.001; RR=1.781, 95%CI=1.511 and 2.099, Z=6.88, P〈0.001; RR=2.351, 95%CI= 1.808 and 3.059, Z=6.37, P〈0.001, respectively）. The tumor shrinkage rate in TACE plus PA group was also better than that in simple TACE group （RR =1.314, 95% CI=1.190 and 1.452, Z=5.38, P〈0.001）. The sensitivity analysis indicated that the results of the differences in survival rate and tumor shrinkage rate between the two groups were reliable. Conclusion The 1-year, 2-year and 3-year survival rates as well as the tumor shrinkage rate of TACE plus PA group are higher than those of simple TACE group. （J lntervent Radiol, 2017, 26： 830-835）