肝细胞癌切除术前应用肝动脉化疗栓塞术疗效的Meta分析

摘要

Objective To assess the efficacy of transcatheter arterial chemoembolization (TACE)in patients with hepatocellular carcinoma (HCC)before hepatectomy.Methods PubMed,Embase,the Cochrane Library,CNKI,VIP,and Wanfang Data were searched to identify randomized controlled trials (RCTs)evaluating the efficacy of preoperative TACE plus hepatectomy (study group)versus hepatectomy alone (control group)in HCC patients published up to March 12,2013.The quality of included studies was assessed,and relevant data were ex-tracted.Statistical analysis was performed by RevMan 5.2.Results A total of 4 RCTs involving 342 participants were included.Meta-a-nalysis of data extracted from the included RCTs showed that there were no significant differences between the study group and control group in 1 -,3-,and 5 -year disease-free survival (DFS),with relative risks (RRs)(95% confidence intervals (CIs))of 1.07 (0.92 -1.25)(P=0.38),1.05 (0.79,1.41)(P=0.72),and 0.95 (0.64-1.42)(P=0.81),respectively,in 1 -,3 -,and 5 -year o-verall survival (OS),with RRs (95% CIs)of 1.01 (0.92-1.10)(P=0.85),1.14 (0.97-1.34)(P=0.11),and 0.95 (0.75 -1.21)(P=0.68),respectively,and in rate ofpostoperative complications and mortality,with RRs (95%CIs)of0.89 (0.45 -1.75)(P=0.73)and 0.77 (0.25 -2.37)(P=0.65),respectively.Conclusion TACE before hepatectomy cannot increase DFS and OS and re-duce complications and mortality in HCC patients.However,the numbers of studies and cases included in the analysis are small,and more high-quality,large-sample RCTs are needed to confirm the conclusion.%目的：旨在评价肝动脉化疗栓塞术（TACE）在肝细胞癌（HCC）切除术前应用的疗效。方法计算机检索PubMed、Em-base、Cochrane library、CNKI、VIP、万方数据库，截止日期到2013年3月12日。收集公开发表的关于HCC切除术前TACE治疗与单纯手术治疗比较的随机对照试验，对纳入的文献进行资料提取和质量评价，采用ReMan5．2软件进行统计分析。结果共纳入4个随机对照试验，共342例患者。Meta分析结果显示：术前TACE组与单用手术切除治疗HCC组相比，术后1、3、5年无瘤生存率的相对危险度（RR）[95％可信区间（CI）]分别为1．07（0．92～1．25）（P＝0．38）、1．05（0．79～1．41）（P＝0．72）、0．95（0．64～1．42）（P＝0．81）；1、3、5年总生存率的RR（95％CI）分别为1．01（0．92～1．10）（P＝0．85）、1．14（0．97～1．34）（P＝0．11）、0．95（0．75～1．21）（P＝0．68）；术后并发症发生率及病死率合并分析其相对危险度的RR（95％CI）分别为0．89（0．45～1．75）（P＝0.73）、0．77（0．25～2．37）（P＝0．65）。2组的术后1、3、5年无瘤生存率、总生存率及术后并发症发生率及病死率比较差异无统计学意义。结论 HCC术前应用TACE不能提高术后无瘤生存率及总生存率。但是本研究中纳入的文献数及病例数均较少，尚需更多高质量的大样本临床随机对照试验进一步验证。