十年来国人原发性肝癌TACE联合3DCRT与单纯TACE疗效的系统评价

摘要

目的：系统评价十年来国人原发性肝癌肝动脉介入栓塞化疗（transcatheter arterial chemoembolization，TACE）联合三维适形放疗（three dimensional conformal radiotherapy，3DCRT）治疗与单纯使用TACE治疗的总有效率与生存率。方法计算机检索PubMed、CBM、CNKI、万方数据库，查找比较国人原发性肝癌TACE联合3DCRT治疗与单纯TACE治疗近期疗效和1年、2年、3年生存率的随机对照试验（RCT），检索时限均为2004年1月至2014年2月，并追溯纳入文献的参考文献。同时，手工检索已发表的资料、会议论文及学位论文。由2位研究者根据纳入与排除标准进行文献筛选、资料提取和质量评价后，采用RevMan 5.1软件进行Meta分析。结果最终纳入20个随机对照试验，包括1511例患者。Meta分析结果显示：TACE联合3DCRT组与单纯TACE组总有效率比较[RR＝2.90，95%CI（2.31，3.64），P＜0.00001]，1年生存率比较[RR＝2.54，95%CI（2.02，3.19），P＜0.00001]，2年生存率比较[RR＝2.75，95%CI（2.22，3.40），P＜0.00001]，3年生存率比较[RR＝3.00，95%CI（2.33，3.87），P＜0.00001]。结论 TACE联合3DCRT较单纯TACE治疗原发性肝癌总有效率提高；1年、2年、3年生存率明显增加，提示临床上TACE联合3DCRT治疗原发性肝癌较单纯使用TACE疗效好。%Objective To systematically evaluate the total efficiency and survival rate of TACE puls 3DCRT compared with TACE alone in the treatment for Chinese primary hepatocellular carcinoma in recent ten years.Methods We electronically searched PubMed, CBM,CNKI and WanFang Data from January 2004 to February 2014 for all RCTs on the use of TACE puls 3DCRT and TACE alone in the treatment for Chinese primary hepatocellular carcinoma.The English and Chinese version of relevant published and unpublished data and their references were also retrieved by hand.The data were extracted and the quality was evaluated by two reviewers independently,and then RevMan 5.0 software was used for data analysis.Results 20 RCTs involving 1511 patients werefinally included.The results of Meta analysis showed that TACE plus 3DCRT,compared with TACE alone,could significantly improved total efficiency and survival (1、2 and 3y) (P<0.00001).Conclusions The therapeutic effect was better with 3 DCRT plus TACE than TACE in primary hepatocellular carcinoma.