TACE联合SBRT治疗原发性肝癌的Meta分析  

A Meta-analysis of transcatheter arterial chemoembolization comparing stereotactic body radiation the-rapy in patients for primary hepatic carcinoma

作　　者：陈亚平[1] 姜晓晓[2] 蒋冠 冯守信[3] 

机构地区：[1] 徐州医学院附属医院肿瘤内科,221000 [2] 徐州医学院附属医院泌尿外科,221000 [3]徐州医学院附属医院立体定向科,221000 [4]江苏省肿瘤生物治疗研究所

出　　处：《国际肿瘤学杂志》2015年第3期182-187,共6页Journal of International Oncology

摘　　要：目的：系统评价经导管肝动脉化疗栓塞术（ TACE ）单用与联合应用体部立体定向放疗（ SBRT）治疗原发性肝癌的疗效和不良反应，为临床实践提供参考。方法检索PubMed、Cochrane Library、EMBase、Ovid、MEDLINE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、医学期刊全文数据库，查找关于TACE和SBRT治疗原发性肝癌的临床对照试验研究。按照Cochrane协作网的RevMan 5.2软件进行Meta分析。分析TACE单用与联合应用SBRT两组间的近期疗效，肿瘤局部控制率，1、2、3、5年生存率的差异。结果共有10篇文献，1143例患者满足纳入标准。Meta分析结果显示， TACE联合SBRT组比单纯TACE组近期疗效，肿瘤局部控制率，1、2、3、5生存率均高（RR＝1.43，95%CI为1.32~1.56，P﹤0.00001；RR＝2.09，95%CI为1.63~2.69，P﹤0.00001；RR＝1.31，95%CI 为1.21~1.42，P﹤0.00001；RR＝1.46，95%CI为1.23~1.72，P﹤0.00001；RR＝1.76，95%CI为1.14~2.71，P＝0.01；RR＝2.29，95%CI为1.22~4.32，P＝0.01）。白细胞减少（ RR＝0.97，P＝0.61）、血小板减少（ RR＝0.99，P＝0.85）、血红蛋白减少（RR＝0.95，P＝0.63）、恶心呕吐（RR＝1.00，P＝0.98）、肝功能损害（RR＝0.98，P＝0.87）的发生率两组之间差异无统计学意义。结论与TACE相比，TACE联合SBRT能明显提高患者近期疗效，提高肿瘤局部控制率和1、2、3、5生存率，同时不增加不良反应发生率，但其长期疗效和安全性尚需开展更多大样本、高质量的临床对照试验加以验证。Objective To compare the clinical efficacy and the adverse reaction of transcatheter arteri-al chemoembolization（ TACE）alone and combined with stereotactic body radiation therapy（ SBRT）in patients with primary hepatic carcinoma by a Meta-analysis. Methods PubMed,Cochrane Library,EMBase,Ovid, MEDLIN,CNKI,CBMdisc,VIP and Wanfang were searched to identify the controlled clinical trials of TACE and SBRT for primary hepatic carcinoma. The obtained data were analyzed using Review Manager version 5. 2 provided by Cochrane Collaboration. To analysis the short-term effect of TACE alone or combined with SBRT, the rate of local tumor control and the difference of one,two,three and five-year survival rate. Results A total of 1 143 patients from 10 controlled clinical trials were involved according to the inclusion criteria. The Meta-analysis showed that TACE and SBRT group significantly increased the short-term effective rate,the rate of local tumor control,l-,2-,3-and 5-year overall survival rates（RR=1. 43,95%CI：1. 32-1. 56,P﹤0. 000 01;RR=2. 09,95%CI：1. 63-2. 69,P﹤0. 000 01;RR=1. 31,95%CI：1. 21-1. 42,P﹤0. 000 01;RR=1. 46, 95%CI：1. 23-1. 72,P﹤0. 000 01;RR=1. 76,95%CI：1. 14-2. 71,P=0. 01;RR=2. 29,95%CI：1. 22-4. 32, P=0. 01）. There was no statistically significant difference between the two groups on adverse events such as leucopenia（RR=0.97,P =0. 61）,thrombocytopenia（RR =0. 99,P =0.85）,hemoglobin decrease（RR =0. 95,P=0. 63）,nausea and vomiting（RR=1. 00,P=0. 98）,liver function damage（RR=0. 98,P=0. 87）. Conclusion Compared with TACE,TACE combined with SBRT can increase the short-term effective rate,the rate of local tumor control,the 1-,2-,3-and 5-year overall survival time of the patients,and does not increase the incidence of adverse reaction. However high-quality trials with large sample sizes are still needed to verify＆amp;nbsp;the long-term efficacy and safety.

关 键 词：肝肿瘤 META分析 肝动脉化疗栓塞 体部立体定向放射 

分 类 号：R735.7[医药卫生—肿瘤]