TACE联合局部消融术治疗不可切除原发性肝癌有效性与安全性的网状Meta分析

Network meta-analysis for efficacy and safety of TACE combined with local ablation in the treatment of unresectable primary liver cancer

目的系统评价经动脉化疗栓塞术(TACE)联合局部消融术治疗不可切除原发性肝癌(PLC)的有效性和安全性,为临床合理治疗提供循证参考。方法计算机检索中国知网、万方数据、维普网、PubMed、Embase、Cochrane图书馆、ClinicalTrials、Web of Science、Ovid、SinoMed,收集TACE联合局部消融术(试验组)对比TACE(对照组)的随机对照试验(RCT);筛选文献、提取资料后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评价工具对纳入文献进行质量评价;采用Stata14.0软件进行Meta分析。结果共纳入39项RCT,共计2294例患者,涉及TACE、TACE+射频消融(RFA)、TACE+微波消融(MWA)、TACE+无水乙醇注射(PEI)、TACE+冷冻消融(CRA)、TACE+高强度超声聚焦消融(HIFU)6种干预措施,以及铂类、蒽环类、嘧啶类似物及多肽类4种化疗药物。Meta分析结果显示,客观缓解率方面,以TACE+RFA、TACE+HIFU、TACE+MWA较高;1年生存率方面,以TACE+PEI、TACE+HIFU、TACE+MWA较高;2年生存率方面,以TACE+HIFU、TACE+MWA、TACE+PEI较高;3年生存率方面,以TACE+HIFU、TACE+PEI、TACE+RFA较高;安全性方面,以TACE+MWA、TACE+RFA、TACE较高。TACE+MWA中,4种化疗药物的疗效比较,差异均无统计学意义(P>0.05)。结论对于不可切除PLC患者,TACE+MWA的疗效和安全性均较好,为最佳组合;TACE+MWA中4种化疗药物的疗效均较好,可个性化选择适宜的化疗药物。

OBJECTIVE To systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with local ablation in the treatment of unresectable primary liver cancer(PLC),and to provide evidence-based reference for rational clinical treatment.METHODS Retrieved from CNKI,Wanfang Data,VIP,PubMed,Embase,Cochrane Library,ClinicalTrials,Web of Science,Ovid and SinoMed,randomized controlled trial(RCT)about TACE combined with local ablation(trial group)versus TACE(control group)were collected.After screening the literature and extracting the data,the bias risk assessment tool recommended by the Cochrane System Evaluator Manual 5.1.0 was used to evaluate the quality of the included literature;Stata14.0 software was used for meta-analysis.RESULTS A total of 39 RCTs were included,including 2294 patients,involving 6 interventions,i.e.TACE,TACE+radiofrequency ablation(RFA),TACE+microwave ablation(MWA),TACE+absolute ethanol injection(PEI),TACE+cryoablation(CRA),TACE+high-intensity ultrasound focused ablation(HIFU),and 4 chemotherapeutic drugs,i.e.platinum,anthracycline,pyrimidine analogues,and polypeptides.The results of meta-analysis showed that in terms of objective remission rate,TACE+RFA,TACE+HIFU and TACE+MWA were higher;in terms of 1-year survival rate,TACE+PEI,TACE+HIFU and TACE+MWA were higher;in terms of 2-year survival rate,TACE+HIFU,TACE+MWA and TACE+PEI were higher;in terms of 3-year survival rate,TACE+HIFU,TACE+PEI and TACE+RFA were higher;in terms of security,TACE+MWA,TACE+RFA and TACE were higher;there was no significant difference in the efficacy of 4 chemotherapeutic drugs in TACE+MWA(P>0.05).CONCLUSIONS For patients with unresectable PLC,TACE+MWA has good efficacy and safety,which is the best combination;the 4 chemotherapeutic drugs in TACE+MWA are all effective,and suitable chemotherapeutic drugs can be selected individually.