经皮射频消融与微波消融治疗肝细胞癌有效性与安全性比较的Meta分析

Clinical effect and safety of percutaneous radiofrequency ablation versus microwave ablation in treatment of hepatocellular carcinoma:a Meta-analysis

目的通过Meta分析和试验序贯分析系统评价经皮射频消融(RFA)和微波消融(MWA)在肝细胞癌(HCC)中的有效性和安全性。方法计算机检索Pub Med、The Cochrane Library(2017年6期)、EMbase、中国生物医学文献数据库(CBM)和中国知网、维普、万方数据库,搜索有关RFA对比MWA治疗HCC的随机对照试验和队列研究,检索时限均为从建库至2017年6月。由2名评价员独立筛选文献、提取资料和评价纳入研究的质量,采用Rev Man5.3软件进行Meta分析,采用TSAv0.9 Beta软件进行试验序贯分析。结果最终纳入6项RCT和11项回顾性队列研究,共1782例患者。Meta分析结果显示:在总体消融率方面2种消融方法差异无统计学意义[比值比(OR)=0.88,95%可信区间(95%CI):0.63~1.22,P=0.44];在总体局部复发率方面2种消融方法差异无统计学意义(OR=1.20,95%CI:0.90~1.59,P=0.21);在1年总体生存率和3年总体生存率方面2种消融方法差异无统计学意义(OR分别为0.72、1.13,95%CI分别为0.45~1.14、0.85~1.50,P值分别为0.16、0.41);通过亚组分析显示在肿瘤直径≤3 cm或者直径在3~5 cm时,2种消融方法在完全消融率及局部复发率方面差异无统计学意义(P值均>0.05);在消融时间方面,MWA组消融时间明显短于RFA组(均数差为8.08,95%CI:4.79~11.37,P<0.001)。在不良反应发生率方面,术后肝区疼痛发生率和术后发热发生率MWA组高于RFA组,差异有统计学意义(P值分别为0.02、<0.01)。对总体消融率、局部复发率和3年生存率进行TSA分析,提示当前证据仍需纳入更多研究。结论 RFA和MWA在治疗HCC效果方面无明显差异,MWA手术时间较短,但并发症发生率较高。

Objective To investigate the clinical effect and safety of percutaneous radiofrequency ablation （RFA） versus microwave ablation （MWA） in the treatment of hepatocellular carcinoma （HCC） using the meta-analysis and trial sequential analysis （TSA）.Methods PubMed,The Cochrane Library （Issue 6,2017）,EMbase,CNKI,VIP,CBM,and Wanfang Data were searched for randomized controlled trials （RCTs） and cohort studies about RFA versus MWA in the treatment HCC published up to June 2017.Two reviewers independently screened the articles,extracted data,and evaluated their quality.RevMan 5.3 was used for the meta-analysis,and TSAv0.9 Beta was used for TSA.Results A total of 6 RCTs and 11 cohort studies were included,with 1782 patients in total.The meta-analysis showed that there were no significant differences between RFA and MWA in complete ablation rate （odds ratio [OR] =0.88,95％ confidence interval[CI]：0.63-1.22,P =0.44）,overall local recurrence rate （OR =1.2,95％ CI：0.90-1.59,P =0.21）,and 1-and 3-year overall survival rates （1-year：OR=0.72,95％ CI：0.45-1.14,P=0.16;3-year：OR=1.13,95％ CI：0.85-1.50,P=0.41）.The subgroup analysis showed that in patients with a tumor diameter of ≤3 cm or 3-5 cm,there were no significant differences in complete ablation rate and local recurrence rate between RFA and MWA,while the MWA group had a significantly shorter ablation time than the RFA group （MD =8.08,95％ CI：4.79-11.37,P ＜ 0.001）.As for the incidence rate of adverse events,the MWA group had significantly higher incidence rates of liver pain and postoperative pyrexia than the RFA group （P =0.02 and P ＜ 0.01）.TSA was performed for complete ablation rate,local recurrence rate,and 3-year survival rate,and the results showed that more studies were needed to support this ev-idence.Conclusion RFA and MWA have a similar clinical effect in the treatment of HCC,and compared with RFA,MWA has a shorter time of operation and a higher incidence rate of complications.