对比微波消融与肝切除术治疗结直肠癌肝转移效果:Meta分析

Comparison on microwave ablation and liver resection for treating liver metastases of colorectal cancer:Meta-analysis

目的采用Meta分析对比微波消融(MWA)与肝切除术(LR)治疗结直肠癌肝转移(CRCLM)的效果和安全性。方法检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、万方、中国知网、维普数据库关于MWA与LR治疗CRCLM的文献,检索时间自建库至2020年8月31日。依据纳入及排除标准筛选文献,以Review Manager 5.3和Stata 14软件进行Meta分析。结果最终纳入13篇文献、共1 534例CRCLM患者,MWA组685例,LR组849例。经异质性检验,1年总体生存率(OS)(I^(2)=0%,P=0.72)、3年OS(I^(2)=0%,P=0.86)、5年OS(I^(2)=0%,P=0.90)均无明显异质性,采用固定效应模型进行分析,结果显示MWA组与LR组间1年OS[HR=0.99,95%CI(0.95,1.02),P=0.44]、3年OS[HR=1.02,95%CI(0.93,1.11),P=0.74]差异均无统计学意义,LR组5年OS高于MWA组[HR=0.82,95%CI(0.69,0.97),P=0.02]。异质性检验示并发症无明显异质性(I^(2)=0%,P=0.78),以固定效应模型进行分析,结果显示MWA组并发症发生率低于LR组[RR=0.35,95%CI(0.23,0.52),P<0.000 01]。结论 MWA治疗CRCLM早、中期疗效(1、3年OS)与LR相当,远期疗效(5年OS)不及LR,但安全性更高。

Objective To compare the efficacy and safety of microwave ablation(MWA) and liver resection(LR)for treating colorectal cancer liver metastases(CRCLM) with meta-analysis. Methods PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, Wanfang, CNKI and VIP database were searched for articles about MWA and LR for CRCLM from the time of database establishment to August 31, 2020. Then the literature were screened according to inclusion and exclusion criteria. Meta-analysis was performed with Review Manager 5.3 and Stata 14 software. Results Totally 13 articles were enrolled, including 1 534 CRCLM patients, with 685 cases in MWA group and 849 cases in LR group. According to the heterogeneity test, there was no obvious heterogeneity among articles reporting 1-year overall survival(OS)(I^(2)=0%, P=0.72), 3-year OS(I^(2)=0%, P=0.86) and 5-year OS(I^(2)=0%, P=0.90). The fixed-effect model was used for analysis, and the results showed that there was no statistical significant difference of 1-year OS(HR=0.99, 95%CI [0.95, 1.02], P=0.44) nor 3-year OS(HR=1.02, 95%CI [0.93, 1.11], P=0.74) between MWA group and LR group. The 5-year OS of LR group was higher than that of MWA group(HR=0.82, 95%CI [0.69, 0.97], P=0.02). The heterogeneity test showed that there was no obvious heterogeneity among articles reporting complications(I^(2)=0%, P=0.78). The fixed-effect model was used for analysis, and the results showed that the complication rate in MWA group was lower than that in LR group(RR=0.35, 95%CI [0.23, 0.52], P<0.000 01). Conclusion The early and mid-term efficacy(1-and 3-year OS) of MWA in treatment of CRCLM were comparable to those of LR, while the long-term efficacy(5-year OS) was inferior to that of LR, but the safety of MWA was higher LR.