替吉奥联合经肝动脉化疗栓塞治疗原发性肝癌疗效及安全性的Meta分析

摘要

目的 评价替吉奥联合经肝动脉化疗栓塞(transcatheter arterial chemoembolization, TACE)治疗原发性肝癌的疗效及安全性.方法 使用计算机检索从建库至2018年2月公开发表在PubMed、Embase、Cochrane和中国期刊全文数据库等多个数据库中替吉奥联合TACE与单独TACE治疗原发性肝癌的疗效相比较的临床研究文献.并使用RevMan 5.3对所纳入的研究进行Meta分析,使用Begg法和Egger法分析发表偏倚.结果 最终纳入9篇研究文献,共569例原发性肝癌患者.其中包括随机对照研究8篇和队列研究1篇.替吉奥联合TACE治疗原发性肝癌的客观有效率及疾病控制率分别为69.8%和89.9%,均优于单独使用TACE的42.9%和65.6%(P均＜0.05);替吉奥联合TACE治疗原发性肝癌的1年、2年及3年总体生存率分别为80.00%、49.74%和37.64%,明显高于单独使用TACE治疗的53.33%、24.10%和14.12%(P均＜0.05).不良反应以骨髓抑制、恶心、呕吐、腹痛和发热多见,予以对症处理后好转,无其他严重不良反应.结论 替吉奥联合TACE治疗原发性肝癌优于TACE治疗,可提高临床疗效,改善患者总体生存率且不良反应可耐受.%Objective To assess the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with S-1 in the treatment of primary hepatic carcinoma (PHC). Methods The published clinical studies regarding the comparison of TACE combined with S-1 and TACE alone in treatment of PHC were collected through a computer-based retrieval from the launching to February 2018, by using PubMed, Embase, Cochrane and China National Knowledge Internet Full-text Databases. RevMan 5.3 software was used for Meta analysis. Publication bias was assessed with Begg and Egger. Results Nine studies involving in 569 PHC cases were enrolled in this study, including 8 randomized controlled trials and 1 cohort study. The objective response rate and disease control rate of TACE combined with S-1 in treatment of PHC were 69.8% and 89.9% respectively, which were higher than those of TACE alone, 42.9% and 65.6% (P＜0.05). The one-year, two-year and three-year overall survival rates of TACE combined with S-1 in treatment of PHC were 80.00%, 49.74% and 37.64%, which were obviously higher than those of TACE alone (53.33%, 24.10% and 14.12%, P ＜ 0.05). Adverse events were mainly bone marrow suppression, nausea, vomiting, abdominal pain and fever, which were improved after symptomatic treatment. No other severe adverse events were observed. Conclusions S-1 combined with TACE in the treatment of PHC is superior to TACE alone. It can improve clinical effect and overall survival rate with tolerable adverse reactions.