Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma A Systematic Review and Meta-analysis
Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma A Systematic Review and Meta-analysis
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DOI：
10.1001/jamaoncol.2015.2189
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发表时间：
2015-09-01
期刊：
影响因子：
28.4
通讯作者：
Eslick, Guy D.
中科院分区：
文献类型：
--
作者：
Huo, Ya Ruth;Eslick, Guy D.
肝细胞癌（HCC）是世界上第二高的癌症相关死亡率，因为大多数患者在不适合手术的中晚期被诊断出来。经导管动脉化疗栓塞术（TACE）目前被认为是不可切除HCC的一线治疗方法。然而，放射治疗（RT）的进步已经导致一些研究确定TACE + RT与TACE单独治疗相比对不可切除的HCC具有显著的治疗益处。目的使用荟萃分析技术评价TACE + RT与TACE单独治疗不可切除的HCC相比的疗效和安全性。资料提取和综合采用随机效应模型计算TACE + RT与TACE单独治疗对生存率、肿瘤反应和不良事件影响的合并优势比（OR）和95% CI。对研究设计、抗癌药物、RT类型、栓塞类型、门静脉肿瘤血栓形成（PVTT）的存在以及TACE和RT治疗之间的时间进行亚组分析。结果共纳入25项临床试验（11项RCT），涉及2577例患者。与单纯TACE相比，接受TACE + RT的患者显示出显著更好的1年生存率（OR，1.36 [95% CI，1.19-1.54]）和完全缓解（治疗后病灶清除）（OR，2.73 [95% CI，1.95-3.81]）。2年、3年、4年和5年生存期的生存获益逐渐增加（分别为：OR，1.55 [95% CI，1.31-1.85]; OR，1.91 [95% CI，1.55-2.35]; OR，3.01 [95% CI，1.38-6.55]; OR，3.98 [95% CI，1.86-8.51]）。与仅接受TACE的患者相比，接受TACE + RT的患者胃十二指肠溃疡的发生率增加，丙氨酸转氨酶和总胆红素水平升高。亚组分析显示，与无PVTT的患者相比，PVTT患者的TACE + RT生存率更高，这一趋势不显着。结论和相关性对于治疗HCC，TACE + RT比单独TACE更有益，应推荐给合适的不可切除的HCC患者。
IMPORTANCE Hepatocellular carcinoma (HCC) has the second-highest cancer-related mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable. Transcatheter arterial chemoembolization (TACE) is currently considered a first-line therapy for unresectable HCC. However, advancements in radiotherapy (RT) have resulted in some studies identifying a significant therapeutic benefit of TACE plus RT for unresectable HCC compared with TACE alone.OBJECTIVE To evaluate the efficacy and safety of TACE plus RT compared with TACE alone for unresectable HCC usingmeta-analytical techniques.DATA SOURCES A search of Medline, EMBASE, PubMed, Cochrane, and Google Scholar databases was done from inception to January 14, 2015.STUDY SELECTION Published trials that included a treatment group receiving TACE plus RT and a control group receiving TACE alone with data for at least 1-year survival or tumor response were included.DATA EXTRACTION AND SYNTHESIS Pooled odds ratios (ORs) and 95% CIswere calculated for the effect of TACE plus RT vs TACE alone on survival, tumor response, and adverse events using a random effects model. Subgroup analyses of study design, anticancer drug, RT type, embolization type, presence of portal venous tumor thrombosis (PVTT), and time between treatments with TACE and RT were performed.MAIN OUTCOMES AND MEASURES Survival, tumor response, adverse events, study design, anticancer drug, RT type, embolization type, presence of PVTT, and time between TACE and RT.RESULTS There were 25 trials (11 RCTs) involving 2577 patients. Patients receiving TACE plus RT showed significantly better 1-year survival (OR, 1.36 [95% CI, 1.19-1.54]) and complete response (clearance of the lesion after treatment) (OR, 2.73 [95% CI, 1.95-3.81]) compared with TACE alone. The survival benefit progressively increased for 2-, 3-, 4-, and 5-year survival (respectively: OR, 1.55 [95% CI, 1.31-1.85]; OR, 1.91 [95% CI, 1.55-2.35]; OR, 3.01 [95% CI, 1.38-6.55]; OR, 3.98 [95% CI, 1.86-8.51]). There was an increased incidence of gastroduodenal ulcers and elevated levels of alanine transaminase and total bilirubin in patients receiving TACE plus RT compared with those receiving TACE alone. Subgroup analyses showed nonsignificant trends in which survival was greater for TACE plus RT in patients with PVTT compared with those without PVTT.CONCLUSIONS AND RELEVANCE TACE plus RT was more therapeutically beneficial than TACE alone for treating HCC, and should be recommended for suitable patients with unresectable HCC.