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 ...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。展开更多
Objective. Most patients with pancreatic cancer show an inoperable locally advanced/ metastatic tumour at the time of diagnosis. The present study was aimed at determining the prognostic factors in patients with advan...Objective. Most patients with pancreatic cancer show an inoperable locally advanced/ metastatic tumour at the time of diagnosis. The present study was aimed at determining the prognostic factors in patients with advanced pancreatic carcinoma treated with gemcitabine. Material and methods. Sixty-seven unresectable or metastatic pancreatic cancer patients treated with gemcitabine were included in the study and a total of 258 cycles of treatment were applied. Results. The overall response rate was 5%. Thirty-one percent of the patients had stable disease, whereas progressive disease was seen in 49%. Clinical benefit response rate was 15%. The median duration of response was 7.3 months. Median progression-free survival was 3 months, while median overall survival was 9 months. Univariate analysis revealed that worse results were found in patients with performance status (PS) =2, and in patients with primary tumour location in the body or tail of the pancreas (p < 0.05). Multivariate analysis of data revealed that the most important factor was PS of the patient, as the patients with PS =2 had worse results than the patients with PS =0-1 (p < 0.05). Conclusions. Low PS is a negative predictive factor for the survival of patients with advanced pancreatic carcinoma treated with gemcitabine.展开更多
文摘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。
文摘Objective. Most patients with pancreatic cancer show an inoperable locally advanced/ metastatic tumour at the time of diagnosis. The present study was aimed at determining the prognostic factors in patients with advanced pancreatic carcinoma treated with gemcitabine. Material and methods. Sixty-seven unresectable or metastatic pancreatic cancer patients treated with gemcitabine were included in the study and a total of 258 cycles of treatment were applied. Results. The overall response rate was 5%. Thirty-one percent of the patients had stable disease, whereas progressive disease was seen in 49%. Clinical benefit response rate was 15%. The median duration of response was 7.3 months. Median progression-free survival was 3 months, while median overall survival was 9 months. Univariate analysis revealed that worse results were found in patients with performance status (PS) =2, and in patients with primary tumour location in the body or tail of the pancreas (p < 0.05). Multivariate analysis of data revealed that the most important factor was PS of the patient, as the patients with PS =2 had worse results than the patients with PS =0-1 (p < 0.05). Conclusions. Low PS is a negative predictive factor for the survival of patients with advanced pancreatic carcinoma treated with gemcitabine.
