射频消融联合经肝动脉化疗栓塞治疗肝癌的疗效与安全性系统评价  

Efficacy and safety of radiofrequency ablation plus transcatheter arterial chemoembolization for hepatocellular carcinoma:a systematic review

作　　者：温路[1] 吴忠均[1] 沈艾[1] 张超[1] 魏续福[1] 刘锐[1] 

机构地区：[1]重庆医科大学附属第一医院肝胆外科,重庆400016

出　　处：《重庆医科大学学报》2014年第7期908-914,共7页Journal of Chongqing Medical University

摘　　要：目的：系统评价射频消融（radiofrequency ablation，RFA）联合经肝动脉化疗栓塞（transcatheter arterial chemoemboliza—tion，TACE）治疗肝细胞性肝癌（hepatocellular carcinoma，HCC）的有效性与安全性。方法：计算机检索PubMed、Cochrane Li—brary、EMBase及CNKI数据库中1978至2013年间的数据，只纳入比较RFA＋TACE与单独RFA治疗HCC的随机对照试验。结果：按照人选标准，有9项临床试验纳入本研究。与单独RFA治疗HCC相比，RFA＋TACE能显著提高患者1、3、5年总生存期（ORl年=2．34，95％CI=I．54-3．57，P=-0．000；OR3年=1．99，95％CI=1．43-2．77，P=0．000；OR54=2．26，95％CI=1．03-4．95，P=0．04）和1、3年无肿瘤复发生存期（ORl年=1．74，95％CI=1．16～2．63，P=0．008；0R3~=2．47，95％CI=1．61—3．80，P=-0．000）。2组之间主要并发症发生率无明显差别（0R=1．24，95％CI=0．79～1．95，P=0．36）。亚组分析显示：RFA＋TACE治疗能明显提高直径在3—5am之间的HCC患者的1、3年总生存期。结论：RFA＋TACE能显著延长HCC患者的无肿瘤复发生存期及总生存期，尤其适合于直径介于3-5cm之间的HCC患者。Objective：To evaluate the efficacy and safety of radiofrequency ablation （RFA） plus transcatheter arterial chemoemboliza- tion （TACE） in the treatment of hepatoeellular carcinoma （ HC C ）. Methods ： PubMed （ 1978 -2013 ）, Cochrane library （ 1978 -2013 ）, EMBase（1978-2013） and CNKI（1978-2013） were searched for randomized controlled trials comparing efficacy of RFA plus TACE and RFA alone for HCC. Results：According to the inclusion criteria,nine studies were selected. Meta analysis data revealed that RFA plus TACE treatment had significantly better effectiveness on 1,3,5-year overall survival rate（OR1 year=2.34,95%C1= 1.54 to 3.57, P=-O.OOO;OR3year=l.99,95%CI=l.43 to 2.77,P=-O.OOO;ORs year=2.26,95%CI=l.03 to 4.95,P=-0.040） and 1,3-year recurrenee free sur- vival rate（OR1 year=l.74,95%Cl=l.16 to 2.63,P=-0.008;OR3 year=2.47,95%CI=l.61 to 3.80,P=-0.000） than those of RFA alone treatment. There was no difference in terms of major complications（OR=l.24,95%Cl=0.79 to 1.95,P=0.360）. Subgroup analyses by tumor size showed that 1,3-year overall survival rate was signifieantly improved in RFA plus TACE treatment than in RFA alone treatment in patients with HCC between 3 em and 5 era. Conclusion：Combination of RFA with TACE can signifieantly improve the reeurrenee free survival and overall survival of patients with HCC ,especially for those with HCC between 3 cm and 5 era.

关 键 词：肝细胞性肝癌 射频消融 肝动脉化疗栓塞 系统评价 

分 类 号：R657.3[医药卫生—外科学]