肝移植术前经肝动脉化疗栓塞对肝细胞肝癌预后影响的系统评价  

Transarterial chemoembolization before liver transplantion for hepatocellular carcinoma: Meta-analysis of its prognostic influence

作　　者：邱斌玉[1] 张金辉[1] 温浩[1] 

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心肝移植腔镜科,乌鲁木齐医学硕士830054

出　　处：《医学研究生学报》2010年第6期613-617,共5页Journal of Medical Postgraduates

基　　金：新疆维吾尔自治区科技厅高技术项目(200810104)

摘　　要：目的肝移植(liver transplantation,LT)是许多不能手术切除的肝细胞肝癌(hepatocellular carcinoma,HCC)患者的治疗选择;LT术前经动脉化疗栓塞(transarterial chemoembolization,TACE)对肿瘤进展、患者生存及肿瘤复发的影响仍不确定。文中对HCC患者LT术前TACE对预后的影响作一评价。方法检索Pubmed、Medline、Embase、Cochrane图书馆和中国生物医学文献数据库、中国期刊全文数据库、万方数据库和中华医学会数字化期刊中的相关文献,语种为英语和汉语,时间为1989年1月1日至2009年3月15日。收集比较在HCC行肝移植术前TACE与未行TACE治疗的随机对照研究(ran-domized controlled trial,RCT)或非随机对照研究(non-randomized controlled trial,NRCT),对符合纳入标准的研究采用Rev-Man4.2软件进行Meta分析。结果肝癌LT纳入研究7篇,均为NRCT,5篇英文,2篇中文;术前TACE与未做TACE比较,1、2、3、5年无瘤生存率的RR值分别为1.05、1.02、0.99和0.99,95%CI分别为(0.94,1.17)、(0.90,1.16)、(0.85,1.15)和(0.83,1.17);1、2、3、5年总生存率的RR值分别为1.09、1.11、1.04和1.15,95%CI分别为(0.97,1.22)、(0.96,1.29)、(0.88,1.22)和(0.94,1.40)。术后并发症及病死率的RR值分别为1.05和0.74,95%CI分别为(0.84,1.31)和(0.19,2.96)结论肝癌LT术前TACE不能明显提高移植后无瘤生存率和总生存率,但可抑制等待LT肝癌患者病程进展并使肿瘤降期,不增加手术及术后并发症,对化疗栓塞的反应可预测预后。Objective Liver transplantation（LT） is a treatment of choice for many patients with unresectable hepatocellular carcinoma（HCC）.However,indefinitiveness remains concerning the influence of pre-LT transarterial chemoembolization（TACE） for HCC on tumor progression,the patient′s survival and HCC recurrence.This study aimed to evaluate the effect of pre-LT TACE on the prognosis of HCC.Methods We searched Medline,Embase,Cochrane Library,CBMdisc,CNKI,Wanfang Database and CMA in the English and Chinese languages for randomized and non-randomized clinical controlled trials（RCT and NRCT） on pre-LT TACE for HCC published from January 1,1989 to March 15,2009,and conducted a meta-analysis on the data extracted from the included studies using the Cochrane Collaboration′s RevMan4.2 software.Results Seven NRCTs on LT were included,2 in Chinese and 5 in English.Comparison between LT combined with preoperative TACE and hepatectomy alone showed that the relative risks（95% CI） of 1-,2-,3-and 5-year disease-free survival were 1.05（0.94,1.17）,1.02（0.90,1.16）,0.99（0.85,1.15） and 0.99（0.83,1.17）,and the overall survival rates were 1.09（0.97,1.22）,1.11（0.96,1.29）,1.04（0.88,1.22） and 1.15（0.94,1.40）,respectively.The rates of postoperative complications and mortality were 1.05（0.84,1.31） and 0.74（0.19,2.96）,respectively.Conclusion Pre-LT TACE does not significantly improve disease-free survival or overall survival of the patient,but it can suppress tumor progression in patients waiting for LT,down-stage the tumor in those with advanced HCC,and help to prognose the response to TACE.Besides it does not increase surgical complications.

关 键 词：肝细胞肝癌 经肝动脉化疗栓塞 肝移植 Meta分析 无瘤生存率 总生存率 

分 类 号：R657.3[医药卫生—外科学]