肝细胞癌合并门静脉癌栓术后辅助TACE联合门静脉化疗临床效果的荟萃分析  

Combined postoperative adjuvant transarterial chemoembolization and portal vein chemotherapy to treat patients with hepatocellular carcinoma and portal vein tumor thrombosis:a meta-analysis

作　　者：柯桥 王垒 林南平 辛富理 曾永毅 刘景丰 Ke Qiao;Wang Lei;Lin Nanping;Xin Fuli;Zeng Yongyi;Liu Jingfeng(Department of Hepatopancreatobiliary Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China;Department of Radiation Oncology,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院肝胆胰外科,福州350025 [2]福建医科大学孟超肝胆医院放疗科,福州350025

出　　处：《中华肝胆外科杂志》2020年第3期192-198,共7页Chinese Journal of Hepatobiliary Surgery

基　　金：福州市科技局(2019-SZ-47)。

摘　　要：目的系统评价经导管肝动脉化疗栓塞(TACE)联合门静脉化疗(PVC)在肝细胞癌合并门静脉癌栓术后辅助治疗中的临床价值。方法计算机检索PubMed、Embase、Cochrane Library、Medline、Web of Science及中国知网、中国生物医学文献数据库、万方、维普等数据库,检索时间2000年1月1日至2019年6月30日,比较肝细胞癌合并门静脉癌栓患者手术后辅助TACE与TACE联合PVC治疗的临床效果,比较术后生存率、无瘤生存率和不良反应。应用RevMan 5.3软件进行荟萃分析,采用比值比(OR)及其95%可信区间(95%CI)表示研究效应量。结果共纳入9篇文献,共642例患者,其中单纯TACE组323例,联合组319例。荟萃分析结果,联合组术后1年(OR=2.20,95%CI:1.53~3.17)、2年(OR=2.44,95%CI:1.69~3.53)、3年(OR=2.30,95%CI:1.52~3.46)生存率均优于单纯TACE组,差异均有统计学意义(均P<0.05)。联合组术后1年(OR=2.56,95%CI:1.70~3.86)、2年(OR=2.27,95%CI:1.19~4.32)、3年(OR=3.03,95%CI:1.55~5.92)无瘤生存率优于单纯TACE组,差异均有统计学意义(均P<0.05)。两组不良反应发生率比较差异均无统计学意义(均P>0.05)。结论肝细胞癌合并门静脉癌栓术后辅助TACE联合PVC治疗安全有效,且优于单纯TACE治疗。但仍需大样本、多中心、前瞻性研究进一步证实。Objective To systematically review the clinical effectiveness of combined postoperative adjuvant transcatheter arterial chemoembolization(TACE)with portal vein chemotherapy(PVC)versus TACE alone in patients with hepatocellular carcinoma(HCC)and portal vein tumor thrombus(PVTT).Methods Databases including PubMed,Embase,Cochrane Library,Medline,Web of Science,CNKI,China Biology Medicine,Wan Fang and VIP were searched from Jan 1st 2000 to Jun 30th 2019 for eligible studies on clinical effectiveness of combined postoperative adjuvant TACE with PVC versus TACE alone in patients with HCC and PVTT.The primary endpoints were overall survival(OS)and disease-free survival(DFS).The secondary endpoint was adverse events.These endpoints were evaluated by odds ratio(OR)and 95%confidence interval(CI)using Review Manager 5.3 software.Results Nine studies with 642 patients were enrolled in this meta-analysis.There were 323 patients in the TACE group and 319 patients in the TACE plus PVC group.The pooled OR for the 1-,2-,and 3-year OS were all significantly better in the TACE plus PVC group than the TACE group(1-year OS,OR=2.20,95%CI:1.53-3.17;2-year OS,OR=2.44,95%CI:1.69-3.53;3-year OS,OR=2.30,95%CI:1.52-3.46)(all P<0.05).Similarly,significantly better results were observed in the pooled OR for the 1-,2-,and 3-year DFS(1-year DFS,OR=2.56,95%CI:1.70-3.86;2-year DFS,OR=2.27,95%CI:1.19-4.32;3-year DFS,OR=3.03,95%CI:1.55-5.92)(all P<0.05).There were no significant differences in the incidences of adverse events between the two groups(all P>0.05).Conclusion Postoperative adjuvant TACE combined with PVC for patients with HCC and PVTT was safe and effective,and was significantly better than TACE alone in long-term prognosis.Large-scale,multi-center,prospective studies are needed to support the conclusion.

关 键 词：癌 肝细胞 门静脉癌栓 经导管肝动脉化疗栓塞 门静脉化疗 荟萃分析 

分 类 号：R735[医药卫生—肿瘤]