Clinical outcome of small hepatocellular carcinoma after different treatments: A meta-analysis
Clinical outcome of small hepatocellular carcinoma after different treatments: A meta-analysis
复制标题
小肝细胞癌不同治疗后临床结果的荟萃分析
DOI：
10.3748/wjg.v20.i29.10174
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发表时间：
2014-08-21
影响因子：
4.3
通讯作者：
Liu, Hui
中科院分区：
文献类型：
--
作者：
Dong, Wei;Zhang, Ting;Liu, Hui
目的：比较手术切除(RES)和非手术切除(NRES)治疗小肝癌的临床疗效。方法：系统检索Medline、Embase和Cochrane图书馆2003年1月至2013年10月期间手术切除和非手术切除治疗小肝癌的研究。评估的临床结果指标包括总存活率、无病存活率、不良事件和局部复发率。采用固定效应模型或随机效应模型计算95%CI的优势比(OR)。计算X(2)和I-2检验以评估数据的异质性。结果：我们的分析包括12项研究，包括总共1952名患者(RES和NRES)，5项研究，包括701名患者[射频消融(RFA)和经皮无水乙醇注射(PEI)]，以及另外5项研究[RFA和RFA+经导管肝动脉化疗栓塞术(TACE)]，这些研究都涉及小肝癌的治疗。Res组与NRES组1年(OR=0.99，95%CI：0.87~1.12，P=0.85)或3年(OR=0.97，95%CI：0.84~1.11，P=0.98)的总生存率无显著差异，而RES组的5年总生存率显著高于NRES组(OR=0.81，95%CI：0.68~0.95，P=0.01)。1年无瘤生存率(OR=0.94，95%CI：0.82~1.08，P=0.37)和5年无瘤生存率(OR=0.99，95%CI：0.85~1.14，P=0.85)差异无统计学意义。3年无瘤生存率(OR=0.81，95%CI：0.69~0.96；P=0.02)高于RES组。资料分析显示，射频治疗与单纯射频治疗相比，2年(OR=0.76，95%CI：0.58~0.99，P=0.043)和3年(OR=0.73，95%CI：0.54~0.98，P=0.039)生存率显著提高；两组1年总生存率及不良事件发生率差异无统计学意义(OR=0.92，95%CI：0.72~1.17，P=0.0502)，差异无统计学意义(OR=1.84，95%CI0.76~4.45，P=0.173)。术后1年(OR=1.17，95%CI：0.88~1.5 6，P=0.2 7)和3年(OR=1.2 5，95%CI：0.90~1.73，P=0.183)生存率差异无统计学意义；术后5年生存率(OR=3.19，95%CI：1.51~6.74，P=0.002)明显高于单纯射频消融组。在分析的研究中，RFA是最有效的单一非手术消融治疗方法。(C)2014百仕登出版集团有限公司，版权所有。
AIM: To compare clinical outcomes between surgical resection (RES) and nonsurgical-RES (nRES) ablation therapies for small hepatocellular carcinoma (HCC).METHODS: MEDLINE, Embase and Cochrane Library databases were systematically searched for studies of RES and nRES treatments for small HCC between January 2003 and October 2013. The clinical outcome measures evaluated included overall survival rate, disease-free survival rate, adverse events, and local recurrence rate. Odds ratios (ORs) with 95%CIs were calculated using either the fixed effects model or random effects model. The chi(2) and I-2 tests were calculated to assess the heterogeneity of the data. Funnel plots were used to assess the risk of publication bias.RESULTS: Our analysis included 12 studies that consisted of a total of 1952 patients (RES vs nRES), five studies that consisted of 701 patients [radiofrequency ablation (RFA) vs percutaneous ethanol injection (PEI)], and five additional studies [RFA vs RFA + transcatheter arterial chemoembolization (TACE)] that all addressed the treatment of small HCC. For cases of RES vs nRES, there was no significant difference in the 1-year (OR = 0.99, 95%CI: 0.87-1.12, P = 0.85) or 3-year (OR = 0.97, 95%CI: 0.84-1.11, P = 0.98) overall survival rate; however, there was a significant increase in the RES group in the 5-year overall survival rate (OR = 0.81, 95%CI: 0.68-0.95, P = 0.01). The 1-year (OR = 0.94, 95%CI: 0.82-1.08, P = 0.37) and 5-year (OR = 0.99, 95%CI: 0.85-1.14, P = 0.85) disease-free survival rates showed no significant differences between the two groups. The 3-year disease-free survival rate (OR = 0.81, 95%CI: 0.69-0.96; P = 0.02) was higher in the RES group. For cases of RFA vs PEI, our data analysis indicated that RFA treatment was associated with significantly higher 2-year (OR = 0.76, 95%CI: 0.58-0.99, P = 0.043) and 3-year (OR = 0.73, 95%CI: 0.54-0.98, P = 0.039) overall survival rates; however, there were no significant differences in the 1-year (OR = 0.92, 95%CI: 0.72-1.17, P = 0.0502) overall survival rate or incidence of adverse events (OR = 1.84, 95%CI: 0.76-4.45, P = 0.173). For cases of RFA vs RFA + TACE, there were no significant differences in the 1-year (OR = 1.17, 95%CI: 0.88-1.56, P = 0.27) or 3-year (OR = 1.25, 95%CI: 0.90-1.73, P = 0.183) overall survival rate; however, the 5-year overall survival rate (OR = 3.19, 95%CI: 1.51-6.74, P = 0.002) in patients treated by RFA + TACE was higher than that treated by RFA alone.CONCLUSION: Surgical resection is superior to nonsurgical ablation for the treatment of small HCC. Among the studies analyzed, RFA is the most efficacious single nonsurgical ablation treatment. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.