射频消融联合经肝动脉化疗栓塞治疗肝癌的疗效与安全性系统评价

Efficacy and safety of radiofrequency ablation plus transcatheter arterial chemoembolization for hepatocellular carcinoma：a systematic review

摘要:

目的：系统评价射频消融（radiofrequency ablation，RFA）联合经肝动脉化疗栓塞（transcatheter arterial chemoemboliza－tion，TACE）治疗肝细胞性肝癌（hepatocellular carcinoma，HCC）的有效性与安全性。方法：计算机检索PubMed、Cochrane Li－brary、EMBase及CNKI数据库中1978至2013年间的数据，只纳入比较RFA+TACE与单独RFA治疗HCC的随机对照试验。结果：按照入选标准，有9 项临床试验纳入本研究。与单独RFA治疗HCC相比，RFA TACE能显著提高患者1、3、5年总生存期（OR1年=2.34，95%CI＝1.54～3.57，P＝0.000；OR3年=1.99，95%CI＝1.43～2.77，P＝0.000；OR5年=2.26，95%CI＝1.03～4.95，P=0.04）和1、3年无肿瘤复发生存期（OR1年=1.74，95%CI＝1.16～2.63，P=0.008；OR3年=2.47，95%CI＝1.61～3.80，P＝0.000）。２组之间主要并发症发生率无明显差别（OR=1.24，95%CI＝0.79～1.95，P=0.36）。亚组分析显示：RFA TACE治疗能明显提高直径在3～5 cm之间的HCC患者的1、3年总生存期。结论：RFA TACE能显著延长HCC患者的无肿瘤复发生存期及总生存期，尤其适合于直径介于3～5 cm之间的HCC患者。

Abstract:

Objective：To evaluate the efficacy and safety of radiofrequency ablation（RFA） plus transcatheter arterial chemoemboliza－tion（TACE） in the treatment of hepatocellular carcinoma（HCC）. Methods：PubMed（1978-2013），Cochrane library（1978-2013），EMBase（1978-2013） and CNKI（1978-2013） were searched for randomized controlled trials comparing efficacy of RFA plus TACE and RFA alone for HCC. Results：According to the inclusion criteria，nine studies were selected. Meta analysis data revealed that RFA plus TACE treatment had significantly better effectiveness on 1，3，5-year overall survival rate（OR1 year=2.34，95%CI=1.54 to 3.57，P=0.000；OR3 years=1.99，95%CI=1.43 to 2.77，P=0.000；OR5 years=2.26，95%CI=1.03 to 4.95，P=0.040） and 1，3-year recurrence free sur－vival rate（OR1 year=1.74，95%CI=1.16 to 2.63，P=0.008；OR3 years=2.47，95%CI=1.61 to 3.80，P=0.000） than those of RFA alone treatment. There was no difference in terms of major complications（OR=1.24，95%CI=0.79 to 1.95，P=0.360）. Subgroup analyses by tumor size showed that 1，3-year overall survival rate was significantly improved in RFA plus TACE treatment than in RFA alone treatment in patients with HCC between 3 cm and 5 cm. Conclusion：Combination of RFA with TACE can significantly improve the recurrence free survival and overall survival of patients with HCC，especially for those with HCC between 3 cm and 5 cm.