TACE联合HIFU治疗原发性肝癌的Meta分析  

TACE Combined with HIFU for Primary Hepatic Carcinomas:A Meta-Analysis

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

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

出　　处：《循证医学》2013年第5期292-299,共8页The Journal of Evidence-Based Medicine

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

摘　　要：目的评价介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的疗效及安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang八大数据库,同时辅以其他检索,收集所有介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌的随机对照试验。两位评价员按照研究计划书进行文献筛选和资料提取,对纳入文献进行质量评价后,使用RevMan 5.1软件进行Meta分析。结果共纳入15篇随机对照试验(1 103例患者)。Meta分析结果显示:①联合组0.5年[风险比5.12,95%可信区间(3.46,7.58)],1年[风险比3.03,95%可信区间(2.26,4.06)],2年[风险比3.51,95%可信区间(2.45,5.02)],3年[风险比3.60,95%可信区间(2.42,5.37)],5年[风险比4.70,95%可信区间(2.41,9.17)]的总生存率和总有效率均明显好于介入化疗栓塞术组,且差异均有统计学意义(P<0.05)。②联合组白细胞下降、恶心呕吐、肝功损害的发生率均低于介入化疗栓塞术组,但只有恶心呕吐发生率的差异有统计学意义;联合组发热反应的发生率高于介入化疗栓塞术组,且差异有统计学意义(P<0.05)。结论相较于单纯介入化疗栓塞术,介入化疗栓塞术联合高强度聚焦超声治疗原发性肝癌能提高患者远期生存率和近期疗效,且安全性很好,但其长期疗效和安全性评价尚需大样本高质量的随机对照试验进一步验证。Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with high-intensity focused ultrasound （HIFU） for primary hepatic carcinomas （PHC）, and to provide the reference for clinical practice and research. Methods We searched foreign databases as Cochrane Library, PubMed, EMBASE, Web of Science and Chinese ones as CBM, CNKI, VIP and Wanfang with computer and also retrieved other sources as supplying, such as tracing related references. All relevant randomized controlled trials （RCTs） were collected to compare combination therapy and TACE alone. After literature screening, data extraction and quality evaluation independently conducted by two authors according to the protocal, the recta-analyses were performed using the RevMan 5.1 software. Results 15 RCTs were involved with 1 103 patients included. Meta-analysis showed： ① The 0.5,1,2,3,5 year overall survival rate and total effective rate in the combination therapy group were superior to TACE alone, and there were significant differences（P〈0.05）; 0.5-year [HR=5.12, 95%CI=（3.46, 7.58）], 1-year [HR=3.03, 95%CI=（2.26, 4.06）], 2-year [HR=3.51, 95%CI=（2.45, 5.02）1, 3-year [HR=3.60, 95%CI= （2.42, 5.37） ], 5-year [ HR=4.70, 95%CI= （2.41,9.17） ]. ② The incidences of combination therapy were lower than those of TACE alone on the indicators of leukocytopenia, nausea and vomiting, hepatic lesion, but it was statistically significant only on the indicators of nausea and vomiting. The incidences of fever was higher in the combination therapy group than the TACE alone group, and there was significant difference （P〈0.05）. Conclusion Compared with the TACE alone, TACE combined with HIFU can improve long-term survival rate and short-term curative effect, and it＇s feasible. But its long-term survival rate and security still needs to be further verified by more large sample and high quality RCTs.

关 键 词：肝肿瘤 高强度聚焦超声 介入化疗栓塞术 随机对照试验 META分析 

分 类 号：R735.7[医药卫生—肿瘤]