TACE联合冷冻消融治疗不可切除肝癌临床疗效的meta分析

TACE combined with cryoablation for inoperable liver cancers : a meta analysis of clinical efficacy

目的对比分析肝动脉化疗栓塞(TACE)联合冷冻消融治疗与单独TACE治疗不可切除肝癌的临床疗效。方法计算机检索关于TACE联合冷冻消融(实验组)与单独TACE治疗(对照组)肝癌的随机对照试验(RCT),制定纳入和排除标准进行筛选,对比分析短期疗效和远期生存率。结果经过纳入标准和排除标准筛选,纳入5篇RCT文献,共418例患者进行meta分析,结果显示:实验组的完全缓解(CR)(RR=2.20,95%CI:1.51~3.22,P<0.000 1)、客观缓解率(ORR)(RR=1.49,95%CI:1.26~1.77,P<0.000 1)、疾病控制率(DCR)(RR=1.23,95%CI:1.12~1.35,P<0.000 1),1年(RR=1.38,95%CI:1.20~1.60,P<0.000 1)和2年(RR=1.68,95%CI:1.23~2.29,P=0.001)生存率明显高于对照组,而疾病进展(PD)(RR=0.38,95%CI:0.24~0.59,P<0.000 1)明显低于对照组。进一步对采用mRECIST短期疗效评价的2篇RCT研究meta分析显示:实验组ORR(RR=1.35,95%CI:1.02~1.78,P=0.03)、DCR(RR=1.27,95%CI:1.07~1.50,P=0.005)明显高于对照组,而PD明显低于对照组(RR=0.36,95%CI:0.17~0.76,P=0.007)。结论 TACE联合冷冻消融治疗不可切除肝癌的临床疗效优于单独TACE治疗。

Objective To compare the clinical efficacy of transcatheter arterial chemoembolization(TACE) combined with cryoablation with that of TACE alone in treating inoperable liver cancers.Methods Computerized retrieval of randomized controlled trial(RCT) papers concerning TACE combined with cryoablation(study group) and TACE alone(control group) for the treatment of patients with inoperable liver cancer was conducted. The inclusion and exclusion criteria were formulated, based on which the patients were screened. The short-term efficacy and long-term survival were compared between the two groups. Results A total of 5 RCT papers including 418 patients were enrolled in this study. Meta analysis showed that complete remission(CR, RR=2.20, 95%CI=1.51-3.22, P=0.000 1), objective remission rate(ORR, RR=1.49,95%CI=1.26-1.77, P<0.000 1), disease control rate(DCR, RR=1.23, 95%CI=1.12-1.35, P<0.000 1),one-year survival rate(RR=1.38, 95%CI=1.20-1.60, P<0.000 1) and two-year survival rate(RR=1.68, 95%CI=1.23-2.29, P=0.001) in the study group were remarkably higher than those in the control group;while the rate of progression disease(PD, RR=0.38, 95%CI=0.24-0.59, P<0.000 1) in the study group was strikingly lower than that in the control group. Further meta analysis of 2 RCT papers,in which mRECIS was used to make short-term efficacy evaluation, indicated that in the study group the ORR(RR=1.35, 95%CI=1.02-1.78, P=0.03)and the DCR(RR =1.27, 95% CI =1.07-1.50, P =0.005) were obviously higher than those in the control group, while the PD(RR=0.36, 95%CI=0.17-0.76, P=0.007) was significantly lower than that in the control group. Conclusion In treating patients with inoperable liver cancer, TACE combined with cryoablation is superior to TACE alone.(J Intervent Radiol, 2021, 30: 804-813)