介入化疗栓塞术联合热疗治疗原发性肝癌的Meta分析  

TACE Combined with Thermotherapy for Primary Hepatic Carcinoma:A Meta-Analysis

作　　者：李征[1,2] 米登海[1,2,3] 杨克虎[1,2] 曹农[1] 田金徽[2] 马彬[2] 

机构地区：[1]兰州大学第一医院,兰州730000 [2]兰州大学循证医学中心,兰州730000 [3]甘肃省第二人民医院,兰州730000

出　　处：《中国循证医学杂志》2012年第6期672-678,共7页Chinese Journal of Evidence-based Medicine

基　　金：甘肃省卫生行业科研计划项目(编号:GSWST09-06);甘肃省自然科学研究基金项目(编号:1010RJZA162);兰州大学循证医学中心循证医学研究生创新基金(编号:2010LDEBM-A)

摘　　要：目的系统评价介入化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合热疗治疗原发性肝癌的疗效及安全性,为临床实践与更深入研究提供参考。方法计算机检索Cochrane Library、PubMed、EMbase、CBM、CNKI、VIP和WanFang Data,同时辅以其他检索,收集所有TACE联合热疗与单纯TACE比较治疗肝癌的随机对照试验(RCT)。按照纳入标准选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan5.1软件进行Meta分析。结果共纳入17个RCT,907例患者。Meta分析结果显示:TACE联合热疗组与单纯TACE组相比,其1、2年生存率、总有效率和生活质量改善率的差异均有统计学意义[1年生存率:HR=2.40,95%CI(1.65,3.48),P<0.000 01;2年生存率:HR=3.28,95%CI(1.87,5.76),P<0.000 1;总有效率:RR=1.59,95%CI(1.42,1.79),P<0.000 01;生活质量改善率:RR=1.79,95%CI(1.42,2.25),P<0.000 01],而且TACE联合热疗组骨髓抑制、消化道反应发生率均低于单纯TACE组,但只有骨髓抑制发生率的差异有统计学意义[RR=0.79,95%CI(0.69,0.92),P=0.001]。结论与单纯TACE相比,TACE联合热疗能明显提高患者1年和2年生存率及近期疗效,改善患者生活质量,且有降低毒副反应发生率的趋势,但其长期疗效和更全面的安全性尚需开展更多大样本、高质量的RCT加以验证。Objective To evaluate the clinical efficacy and salety ot transcatheter arterial chemoembolization （TACE） combined with thermotherapy for primary hepatic carcinoma （PHC）, and to provide references for clinical prac- tice and research. Methods The following databases as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched electronically, and the other sources as supplying, such as tracing related references, were also retrieved. Besides, some unknown information was also obtained by communicating with other authors. All rand- omized controlled trials （RCTs） on TACE combined with thermotherapy versus TACE alone were collected. The literature was screened according to inclusive criteria, data were extracted and the quality of included studies was assessed, and then meta-analysis was conducted using RevMan 5.1 software. Results A total of 17 RCTs with 907 patients were included. Meta-analysis showed that compared with TACE alone, TACE combined with thermotherapy had a significant differ- ence in 1-year survival rate （HR=2.40, 95%CI 1.65 to 3.48, P〈0.000 01）, 2-year survival rate （HR=3.28, 95%CI 1.87 to 5.76, P〈0.000 1）, total effective rate （RR=1.59, 95%CI 1.42 to 1.79, P〈0.000 1） and improvement rate of life quality （RR=1.79, 95%CI 1.42 to 2.25, P〈0.000 1）. The incidences of myelosuppression and alimentary canal reactions were lower in TACE combined with thermotherapy group than those in TACE alone group, but statistically significance was only found in myelosuppression （RR=0.79, 95%CI 0.69 to 0.92, P=0.001）. Conclusion Compared with TACE alone, TACE combined with thermotherapy can improve long-term survival rate and short-term curative effect, ameliorate the quality of life, and tend to reduce the incidence rate of side effects. But its long-term curative effect and more comprehensive safety still needs to be further verified by more large sample and high quality RCTs.

关 键 词：原发性肝癌 热疗 介入化疗栓塞术 META分析 系统评价 随机对照试验 

分 类 号：R735.7[医药卫生—肿瘤]