立体定向放疗联合肝动脉化疗栓塞治疗原发性肝癌系统评价和Meta分析

Stereotactic body radiation therapy combined with transcatheter arterial chemoembolization for primary hepatic carcinoma:A systematic review and Meta analysis

目的作为威胁性极大的高发癌症,肝癌具有起病隐匿、不易手术且术后复发率高的特点,因此放化疗、栓塞等非手术治疗成为主要治疗手段。本研究目的在于系统评价立体定向放疗(stereotactic body radiation therapy,SBRT)联合肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌的疗效及安全性。方法计算机检索Central、PubMed、EMbase、CNKI、VIP和CBM等数据库,并人工检索所纳入研究的参考文献,获取所有SBRT联合TACE治疗原发性肝癌疗效及安全性的随机对照研究。依据纳入和排除标准进行文献筛选纳入,并根据Cochrane Handbook 5.1.2的偏倚风险评估标准及Jadad量表评分工具对纳入研究的方法学质量进行评价,通过RevMan 5.3软件进行Meta分析。结果本系统评价纳入10个随机对照研究,共1 058例患者。Meta分析结果显示,SBRT联合TACE与单纯SBRT相比较,对原发性肝癌的近期有效率相对较高,P<0.001;并且在提高原发性肝癌患者的1(P<0.001)、2年(P<0.001)生存率上明显优于SBRT。SBRT联合TACE在增加骨髓抑制发生率上高于SBRT,P=0.02;但在放射性肝病发生、发热、过敏反应、胃肠道反应及肝肾功能损害等不良反应方面,2组差异无统计学意义,P>0.05。倒漏斗图提示,临床近期有效率的文献存在发表偏倚的可能性较低。结论目前文献证据表明,SBRT联合TACE治疗原发性肝癌比单独SBRT治疗肝癌近期疗效更好,并提高远期生存率,且安全性近似。为进一步证实上述结论,尚需开展更多大样本、高质量的随机对照试验。

OBJECTIVE As a highly threatening cancer,hepatic carcinoma has the characteristics of concealment,in- operability and high postoperative recurrence rate. Therefore, chemoradiotherapy, embolization and other non-operative treatments become the main theruputic methods. This systematic review aims to evaluate the effectiveness and safety of stereotactic body radiation therapy（SBRT） combined with transcatheter arterial chemoembolization（TACE） for primary hepatic carcinoma（PHC） ,compared with SBRT alone. METHODS Electronic databases,including PubMed,Central,EM- base,CNKI,CBM and VIP,were searched for all randomized control trials（RCTs） about SBRT combined with TACE in treating PHC. In addition, all the references of involved studies were manually searched. According to the inclusive and ex- clusive criteria, papers were screened and the methodological quality of the included studies was assessed according to Co chrane Handbook 5.1.2 and Jadad scale. All statistical analyses were performed using RevMan V. 5.3 after the relevant data were extracted. RESULTS Ten RCTs with a total of 1 058 participants were included in this Meta-analysis. SBRT combined with TACE significantly improved the total effective rate （P〈0. 001）, survival rate after 1-year （P〈0. 001） and 2 years （P〈0. 001）, respectively, compared with that Of SBRT alone. In terms of safety,SBRT combined with TACE increased the incidence of bone marrow suppression （P=0.02） compared with SBRT alone while didn＇t show significant differences in other side effects, including radiation hepatitis, pyrexia, anaphylactic reaction, gastrointestinal reaction and functional lesion of liver and kidney. The funnel plot showed publication bias reported the total effective rate was low. CONCLUSIONS Compared with SBRT alone,SBRT combined with TACE improves the recent clinical effectiveness and long-term survival rate and is similarly safe. But further RCTs are needed to prove the conclusion.