载药微球与传统碘化油经肝动脉化疗栓塞术治疗不可切除肝癌效果比较的Meta分析

Clinical effect of drug-eluting beads and conventional transcatheter arterial chemoembolization in treatment of unresectable liver cancer: A meta-analysis

目的系统评价载药微球经肝动脉化疗栓塞术(DEB-TACE)与常规经导管动脉化疗栓塞术(cTACE)经导管动脉化疗栓塞治疗不可切除肝癌的疗效。方法检索PubMed、Embase、Cochrane library和CNKI数据库中有关DEB-TACE与cTACE治疗不可切除肝癌的临床对照试验的文献。根据纳入和排除标准筛选文献,筛选出有效数据后,采用Revman 5.3软件进行Meta分析,比较两者完全缓解(CR)率、部分缓解(PR)率、术后疾病稳定(SD)率、6个月和12个月生存率。结果共纳入12篇文献,共1177例患者,519例患者接受DEB-TACE治疗,658例接受cTACE治疗。与cTACE组相比,DEB-TACE组CR率显著增加[相对风险度(RR)=1.42;95%可信区间(95%CI):1.18~1.72,P=0.0002],术后12个月生存率显著增加(RR=1.09;95%CI:1.01~1.17,P=0.03)。两组PR率(RR=1.13;95%CI:0.97~1.30,P=0.12)、SD率(RR=0.82;95%CI:0.64~1.05,P=0.12)、6个月生存率(RR=1.05;95%CI:1.00~1.10,P=0.07)无显著性差异。结论与碘化油TACE相比,载药微球更具疗效优势的趋势。

Objective To systematically review the clinical effect of transcatheter arterial chemoembolization with drug-eluting beads(DEB-TACE) versus conventional transcatheter arterial chemoembolization(cTACE) in the treatment of unresectable liver cancer.Methods PubMed,Embase,Cochrane,and CNKI were searched for articles on clinical control trials of DEB-TACE versus cTACE in the treatment of unresectable liver cancer.The articles were screened according to inclusion and exclusion criteria,and after valid data were extracted,Revman 5.3 software was used for meta-analysis.The two groups were compared in terms of the number of patients with complete remission(CR),partial remission(PR),or stable disease(SD) and 6-and 12-month survival rates.Results A total of 12 articles were included,with 1177 patients in total,among whom 519 patients underwent DEB-TACE and 658 underwent cTACE.Compared with the cTACE group,the DEB-TACE group had a significantly higher number of patients with CR(risk ratio [RR]= 1.42,95% confidence interval [CI]: 1.18-1.72,P = 0.0002),and had a significantly higher 12-month survival rate(RR = 1.09,95% CI: 1.01-1.17,P =0.03).There were no significant differences between the two groups in the number of patients with PR(RR = 1.13,95% CI: 0.97-1.30,P = 0.12),the number of patients with SD(RR = 0.82,95% CI: 0.64-1.05,P = 0.12),6-month survival rate(RR = 1.05,95% CI: 1.00-1.10,P = 0.07).Conclusion DEB-TACE has a better therapeutic effect than cTACE with iodinated oil.