Transarterial chemoembolization for unresectable hepatocellular carcinoma:: Meta-analysis of randomized controlled trials
Transarterial chemoembolization for unresectable hepatocellular carcinoma:: Meta-analysis of randomized controlled trials
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DOI：
10.1148/radiol.2241011262
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发表时间：
2002-07-01
期刊：
影响因子：
19.7
通讯作者：
Cottone, M
中科院分区：
文献类型：
--
作者：
Cammà, C;Schepis, F;Cottone, M
目的：回顾化疗栓塞治疗不可切除肝细胞癌（HCC）的现有证据。材料和方法：从1980年到2000年，通过MEDLINE和CANCERLIT数据库进行计算机书目检索，辅以人工检索，检索关键词为“肝细胞癌”、“肝细胞癌”、“随机对照试验[RCT]”和“化疗栓塞”。纳入不可切除HCC患者的研究，以及比较化疗栓塞与非主动治疗的随机对照试验（5项随机对照试验）或比较不同经动脉治疗方式的随机对照试验（13项随机对照试验）。根据意向治疗法从每个RCT中提取数据。5个非积极治疗组的随机对照试验采用随机效应模型进行合并，而所有18个随机对照试验均采用meta回归分析。结果：与非积极治疗相比，化疗栓塞显著降低了总2年死亡率（优势比0.54;95% Cl: 0.33, 0.89; P = 0.015）。对比rct分析有助于预测经动脉栓塞（TAE）患者的总死亡率显著低于经动脉化疗（0.72;95% Cl: 0.53, 0.98; P = 0.039），并且没有证据表明经动脉化疗栓塞比TAE更有效（优势比，1.007;95% Cl: 0.79, 1.27; P = 0.95），这表明添加抗癌药物并没有提高治疗效益。结论：在不可切除的HCC患者中，与非积极治疗相比，化疗栓塞显著提高了总2年生存率，但获益幅度相对较小。(c) rsna， 2002年。
PURPOSE: To review the available evidence of chemoembolization for unresectable hepatocellular carcinoma (HCC).MATERIALS AND METHODS: Computerized bibliographic searches with MEDLINE and CANCERLIT databases from 1980 through 2000 were supplemented with manual searches, with the keywords "hepatocellular carcinoma," "liver cell carcinoma," "randomized controlled trial [RCT]," and "chemoembolization." Studies were included if patients with unresectable HCC were enrolled and if they were RCTs in which chemoembolization was compared with nonactive treatment (five RCTs) or if different transarterial modalities of therapy (13 RCTs) were compared. Data were extracted from each RCT according to the intention-to-treat method. Five of the RCTs with a nonactive treatment arm were combined by using the random-effects model, whereas all 18 RCTs were pooled from meta-regression analysis.RESULTS: Chemoembolization significantly reduced the overall 2-year mortality rate (odds ratio, 0.54; 95% Cl: 0.33, 0.89; P = .015) compared with nonactive treatment. Analysis of comparative RCTs helped to predict that overall mortality was significantly lower in patients treated with transarterial embolization (TAE) than in those treated with transarterial chemotherapy (odds ratio, 0.72; 95% Cl: 0.53, 0.98; P = .039) and that there is no evidence that transarterial chemoembolization is more effective than TAE (odds ratio, 1.007; 95% Cl: 0.79, 1.27; P = .95), which suggests that the addition of an anticancer drug did not improve the therapeutic benefit.CONCLUSION: In patients with unresectable HCC, chemoembolization significantly improved the overall 2-year survival compared with nonactive treatment, but the magnitude of the benefit is relatively small. (C) RSNA, 2002.