射频消融与手术治疗结直肠癌肝转移疗效的Meta分析

Meta-analysis of radiofrequency ablation and surgical resection in treatment of colorectal liver metastases

目的比较射频消融(RFA)与肝脏切除术(HR)在结直肠癌肝转移(CRLM)患者治疗中的作用。方法系统检索Cochrane library、Pub Med、荷兰医学文摘(EMbase)、中国知网、万方数据库、维普数据库从建库至2018年5月关于比较RFA和HR治疗CRLM患者的临床对照研究,并对所有的纳入研究进行质量评价,采用Cochrane library提供的软件Rev Man 5.3进行分析。结果最后纳入文献26篇,共包括3738例患者,其中RFA组1447例,HR组2291例。Meta分析结果显示:RFA组5年总生存率、5年无病生存率明显低于HR组(OR=2.42,95%CI:1.64～3.57,P <0.000 01;OR=2.33,95%CI:1.37～3.98,P=0.002);RFA组局部复发率、肝内复发率明显高于HR组(OR=9.29,95%CI:6.88～12.54,P <0.000 01;OR=2.03,95%CI:1.45～2.83,P <0.0001);RFA组术后总并发症发生率低于HR组(OR=0.47,95%CI:0.29～0.76,P=0.002)。结论 RFA并发症发生率明显低于HR,但生存率较低,复发率较高。HR仍是CRLM首选的治疗方式。

Objective To compare the therapeutic efficacy between radiofrequency ablation(RFA)and hepatic resection(HR)for colorectal liver metastases(CRLM).Methods Systematic literature search of clinical trials was carried out to compare RFA and HR for colorectal liver metastasis in Cochrane library,PubMed,Embase,CNKI,Wanfang and VIP from database inception to May 2018.The quality of the included studies was assessed and the data analysis was performed by software RevMan 5.3 from Cochrane library.Results Finally 26 trials including 3738 cases were included,with 1447 cases in RFA group and 2291 cases in HR group.The results of Meta-analysis showed:5-year overall survival and 5-year disease-free survival were significantly lower in RFA group than HR group(OR=2.42,95%CI:1.64-3.57,P﹤0.000 01;OR=2.33,95%CI:1.37-3.98,P=0.002).Local recurrence and intrahepatic recurrence rates were significantly higher in RFA group than HR group(OR=9.29,95%CI:6.88-12.54,P﹤0.000 01;OR=2.03,95%CI:1.45-2.83,P﹤0.0001).RFA had significantly lower postoperative complication rate than HR group(OR=0.47,95%CI:0.29-0.76,P=0.002).Conclusion The complication rate in patients treated by RFA is significantly lower than HR,but survival rate is lower and recurrence rate is higher by RFA than HR.HR is still the preferred treatment for CRLM.