射频消融与手术切除治疗早期肝细胞癌疗效比较Meta分析  

Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma: a Meta-analysis

作　　者：崔瑞文 朱曙光[1] 范磊[2] 郑世杨 李华[1] Cui Ruiwen Zhu Shoguang Fan Lei Zheng Shiyang Li Hoa(Department of Liver Surgery Department of Spine Surgery Department of Breast and Thyroid Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院肝脏外科,广州3510630 [2]中山大学附属第三医院脊柱外科,广州3510630 [3]中山大学附属第三医院甲乳外科,广州3510630

出　　处：《中华肝脏外科手术学电子杂志》2017年第4期280-284,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81172038);广东省自然科学基金(2014A020212484)

摘　　要：目的比较射频消融(RFA)和手术切除(SR)治疗早期肝细胞癌(肝癌)的疗效。方法计算机检索2004年1月至2017年2月在Pub Med、Embase、Web of science、中国知网和万方数据库公开发表的有关RFA和SR治疗早期肝癌的文献。英文检索词包括:hepatocellular carcinoma、liver cancer、hepatic carcinoma、liver neoplasms、HCC、radiofrequency ablation、ablative therapy、RFA、surgical resection、hepatectomy。中文检索词包括:肝细胞癌、肝癌、肝脏肿瘤、射频消融、手术切除。对符合米兰标准的早期肝癌患者提取生存率、并发症发生率及围手术期住院时间等数据进行Meta分析。异质性研究采用随机效应模型分析,同质性研究采用固定效应模型分析。结果共纳入20篇文献,其中4篇为随机对照试验研究,16篇为回顾性研究。共包括3 849例早期肝癌患者,其中1 946例行SR治疗,1 903例行RFA治疗。SR患者术后3、5年总体生存率较RFA患者明显升高(OR=1.09,1.58;P<0.05)。SR患者术后1、3、5年无瘤生存率较RFA患者明显升高(OR=1.88,2.31,2.14;P<0.05)。SR患者术后1、3、5年肿瘤复发率较RFA患者明显降低(OR=0.57,0.18,0.46;P<0.05)。SR患者术后并发症发生率较RFA患者明显升高(OR=3.84,P<0.05)。SR患者围手术期住院时间较RFA患者明显延长(WMD=7.08,P<0.05)。结论对于符合米兰标准的早期肝癌患者,SR长期生存及复发方面明显优于RFA,但RFA具有微创、并发症发生率低、住院时间短等优势。Objective To compare the clinical efficacy between radiofrequency ablation （RFA） and surgical resection （SR） for early hepatocellular carcinoma （HCC）. Methods Open published literatures related to RFA and SR for the treatment of early HCC between January 2004 and February 2017 were searched by computer from PubMed, Embase, Web of science, CNKI and Wanfang databases. The researching keywords in Chinese and English included hepatocellular carcinoma, liver cancer, hepatic carcinoma, liver neoplasms, HCC, radiofrequency ablation, ablative therapy, RFA, surgical resection and hepatectomy. The clinical data including survival rate, incidence of complication and perioperative length of hospital stay of the early HCC patients up to the standard of Milan criteria were extracted for Meta-analysis. Heterogenous studies were analyzed using random effect model, and homogenous studies were analyzed using fixed effect model. Results A total of 20 literatures including 4 randomized control trials and 16 retrospective studies were included in this Meta-analysis. In total, 3 849 patients with early HCC were analyzed. Among the patients, 1 946 cases underwent SR and 1 903 underwent RFA. The postoperative 3-, 5-year overall survival rate of the SR patients was significantly higher than those of the RFA patients （OR=1.09, 1.58; P〈0.05）. The postoperative 1-, 3-, 5-year tumor-flee survival rate of the SR patients was significantly higher than those of the RFA patients （OR=1.88, 2.31, 2.14; P〈0.05）. The postoperative 1-, 3-, 5-year tumor recurrence rate of the SR patients was significantly lower than those of the RFA patients （OR=0.57, 0.18, 0.46; P〈0.05）. The incidence of postoperative complications of the SR patients was significantly higher than that of the RFA patients （OR=3.84, P〈0.05）. The perioperative length of hospital stay of the SR patients was significantly higher than that of the RFA patients （WMD=7.08, P〈0.05）. Conclusions For early HCC patients up to the standard of Milan criteri

关 键 词：癌 肝细胞 导管消融术 肝切除术 疗效比较研究 

分 类 号：R735.7[医药卫生—肿瘤]