肝癌消融术后局部复发与早期复发危险因素的Meta分析

Meta-analysis of Risk Factors for Local Recurrence and Early Recurrence After Ablation Procedure of Liver Cancer

目的系统评价肝癌单纯消融术后局部复发与早期复发(术后1年内)的危险因素。方法计算机检索CNKI、WanFang Data、VIP、Web of science、PubMed、EMbase、SinoMed、The Cochrane Library数据库,搜集有关肝癌消融术后复发危险因素的病例-对照研究和队列研究,检索时限均为建库至2022年5月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析。结果其纳入22篇文献,发表时间为2012-2022年,根据纳入标准剔除2篇,最终纳入14篇研究局部复发、6篇研究早期复发的文献,分别包括5836例、728例患者。Meta分析结果显示,局部复发的危险因素包括肿瘤直径>2 cm(RR=1.92,95%CI:1.54~2.38,P<0.00001)、肿瘤靠近大血管(RR=2.36,95%CI:1.79~3.11,P<0.00001)、肿瘤靠近横膈(RR=2.50,95%CI:1.61~3.87,P<0.0001),其它危险因素包括消融安全边界不足、ADC图低信号;早期复发的危险因素包括肿瘤数≥2个(OR=4.02,95%CI:2.25~7.17,P<0.00001)、甲胎蛋白(AFP)>400 ng/ml(OR=4.19,95%CI:1.47~11.93,P=0.007)、白蛋白(ALB)≤35 g/L(OR=0.36,95%CI:0.16~0.79,P=0.01)。结论严格控制消融的纳入标准,对于肿瘤数量多、直径大、高风险位置、肿瘤标志物高、结合影像学高危征象,可行联合治疗或者手术切除,以减少肝癌术后复发率。

Objective To systematically evaluate the risk factors of local recurrence and early recurrence(within 1 year after operation)after ablation procedure of liver cancer.Methods CNKI,WanFang Data,VIP,Web of science,PubMed,EMbase,SinoMed and The Cochrane Library databases were searched by computer to collect case-control studies and cohort studies on the risk factors of recurrence after ablation procedure of liver cancer from the database construction to May 2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.3 software.Results 22 articles were included,published from 2012 to 2022,and 2 articles were excluded according to the inclusion criteria.Of 14 articles about local recurrence and 6 articles about early recurrence were included,with 5836 patients and 728 patients respectively.The results of Meta-analysis showed that the risk factors of local recurrence included tumor diameter>2 cm(RR=1.92,95%CI:1.54-2.38,P<0.00001),tumor near large blood vessels(RR=2.36,95%CI:1.79-3.11,P<0.00001),tumor near the diaphragm(RR=2.50,95%CI:1.61-3.87,P<0.0001),and other risk factors included insufficient ablation safety boundary and low signal of ADC map.The risk factors for early recurrence included the number of tumors≥2(OR=4.02,95%CI:2.25-7.17,P<0.00001),AFP>400 ng/ml(OR=4.19,95%CI:1.47-11.93,P=0.007),ALB≤35 g/L(OR=0.36,95%CI:0.16-0.79,P=0.01).Conclusion Strictly control the inclusion criteria of ablation.For the large number of tumors,large diameter,high-risk location,high tumor markers and high-risk signs in combination with imaging,combined treatment or surgical resection is feasible to reduce the postoperative recurrence rate of liver cancer.