中国人群不可切除中晚期肝癌的肝动脉化疗栓塞联合二期手术切除与单纯肝动脉化疗栓塞治疗临床疗效的Meta分析

A Meta-analysis of the clinical efficacy of hepatic arterial chemoembolization combined with second-stage surgical resection and hepatic arterial chemoembolization alone for unresectable intermediate and advanced liver cancer in Chinese population

目的比较肝动脉化疗栓塞术后联合二期手术切除与单纯肝动脉化疗栓塞治疗中国人群不可切除中晚期肝癌的临床疗效。方法通过计算机和人工检索收集国内关于肝动脉化疗栓塞联合二期手术与单独肝动脉化疗栓塞治疗无法手术切除肝癌的临床对照研究文献,采用Revman 5.2软件,应用异质性检验分析,对符合纳入标准的17项研究进行Meta分析。结果与肝动脉化疗栓塞联合二期手术相比,单纯肝动脉化疗栓塞的术后1年、2年及3年死亡风险更高(OR=2.82、2.22、3.40,P<0.05)。另外相同化疗栓塞药物条件下,与肝动脉化疗栓塞联合二期手术相比,单纯肝动脉化疗栓塞的术后1年及3年死亡风险更高(OR=6.74、4.64,P<0.05)。与单纯肝动脉化疗栓塞相比,肝动脉化疗栓塞联合二期手术的术后1年疾病进展风险降低(OR=0.46),但差异无统计学意义(P>0.05)。术后2年疾病进展风险仍继续降低(OR=0.29,P<0.05)。结论肝动脉化疗栓塞联合二期手术治疗无法手术切除的肝癌的远期疗效较单独肝动脉化疗栓塞治疗好,能有效提高患者生存率及降低疾病进展率。

Objective The aim of this study was to compare the clinical efficacy of hepatic artery chemoembolization combined with two-stage surgical resection and simple hepatic arterial chemoembolization in the treatment of unresectable advanced liver cancer in the Chinese population.Methods A clinical controlled study literature was collected in China through computer and manual retrieval on the combination of hepatic arterial chemoembolization with two-stage surgery and hepatic arterial chemoembolization alone for the treatment of unresectable liver cancer.A Meta-analysis was conducted on 17 experiments that met the inclusion criteria using Revman 5.2 software and applying heterogeneity test analysis.Results Compared with the combination of hepatic artery chemoembolization and phaseⅡsurgery,simple hepatic arterial chemoembolization had higher postoperative 1-year,2-year and 3-year risk of death(OR=2.82,2.22 and 3.40,P<0.05).In addition,under the same conditions of chemoembolization drugs,compared with the combination of hepatic arterial chemoembolization and phaseⅡs,simple hepatic arterial chemoembolization had higher postoperative 1-year and 3-year risk of death(OR=6.74,4.64,P<0.05).Compared with simple hepatic arterial chemoembolization,thehe combination of hepatic arterial chemoembolization and phase II surgery had a lower 1-year disease progression risk(OR=0.46),but there was no significant difference(P>0.05).The disease progression risk continued to decrease 2 years after surgery(OR=0.29,P<0.05).Conclusion The long-term efficacy of hepatic arterial chemoembolization combined with two-stage surgery in the treatment for unresectable liver cancer is better than that of hepatic arterial chemoembolization alone,whic can effectively improve patients survival and reduce disease progression rate.