Efficacy and safety of thermal ablation of lung malignancies: A Network meta-analysis.
Efficacy and safety of thermal ablation of lung malignancies: A Network meta-analysis.
复制标题
DOI：
10.4103/atm.atm_392_17
复制
发表时间：
2018-10
影响因子：
2.3
通讯作者：
Chen S
中科院分区：
文献类型：
--
作者：
Jiang B;Mcclure MA;Chen T;Chen S
本研究的目的是比较射频消融（RFA）、冷冻消融和微波消融（MWA）治疗肺部恶性肿瘤患者的有效性和安全性。我们进行了一项网络荟萃分析，通过检索截至2017年12月31日的PubMed、Embase和科克伦图书馆，识别来自使用RFA、MWA或冷冻消融治疗恶性肺肿瘤的相关试验的直接和间接证据。我们使用预定义的数据表从已发表的研究中提取相关信息，并使用科克伦偏倚风险工具评估偏倚风险。主要结局为疗效（局部进展率和总生存率）和安全性（主要并发症发生率）。我们在贝叶斯框架内进行了随机效应网络荟萃分析，并使用GRADE框架评估了有助于每个网络估计的证据质量。我们收集了34项符合条件的研究，其中包括1840名参与者和2520例肺部恶性肿瘤（1318例原发性肺癌和1202例肺转移瘤）。在大多数比较中，证据质量被评为非常低。从局部进展率来看，RFA和MWA明显比冷冻消融更有效，比值比（OR）分别为0.04（95%置信区间[CI]：0.004，0.38; P = 0.005）和0.02（95% CI：0.002，0.24; P = 0.001）。MWA和RFA之间无显著差异，OR为0.63（95% CI：0.04，10.39; P = 0.745）。在主要并发症方面，RFA、MWA和冷冻消融的安全性相当（P > 0.05）。对于恶性肺肿瘤患者，RFA和MWA优于冷冻消融。
The objective of this study was to compare the efficacy and safety of radiofrequency ablation (RFA), cryoablation, and microwave ablation (MWA) for patients with lung malignancies. We performed a network meta-analysis to identify both direct and indirect evidence from relevant trials by searching PubMed, Embase, and the Cochrane Library to December 31, 2017, for the treatment of malignant lung tumors with the use of RFA, MWA, or cryoablation. We extracted the relevant information from the published studies with a predefined data sheet and assessed the risk of bias with the Cochrane risk of bias tool. The primary outcomes were efficacy (local progression rate and overall survival rate) and safety (major complications rate). We did a random-effects network meta-analysis within a Bayesian framework as well as assessed the quality of evidence contributing to each network estimate using GRADE framework. We collected 34 studies eligible which included 1840 participants and 2520 lung malignancies (1318 primary lung cancer and 1202 pulmonary metastatic tumors). The quality of evidence was rated as very low in most comparisons. From the point of local progression rate, RFA and MWA were significantly more effective than cryoablation with odds ratio (OR) of 0.04 (95% confidence interval [CI]: 0.004, 0.38; P = 0.005) and 0.02 (95% CI: 0.002, 0.24; P = 0.001), respectively. No significant difference was found between MWA and RFA with an OR of 0.63 (95% CI: 0.04, 10.39; P = 0.745). Regarding the major complications, RFA, MWA, and cryoablation showed the comparable safety (P > 0.05). RFA and MWA offer an advantage over cryoablation for patients with malignant lung tumors.