TACE联合门静脉支架及^125Ⅰ粒子植入治疗肝细胞癌合并门静脉癌栓临床疗效的Meta分析  

Meta-analysis of clinical efficacy of TACE combined with portal vein stenting andⅠin patients with hepatocellular carcinoma combined with portal vein tumor thrombus

作　　者：颜克松 刘凯[2] 柴冰燕 赵玉琪 牛树国 谢凡 柴文晓[1] Yan Ke-song;Liu Kai;Chai Bing-yan;Zhao Yu-qi;Niu Shu-guo;Xie Fan;ChaiWen-xiao(Department of Interventional Oncology,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Public Health Management,Gansu Provincial Hospital,Lanzhou 730000,China;School of Clinical Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院介入肿瘤科,甘肃兰州730000 [2]甘肃省人民医院公共卫生管理科,甘肃兰州730000 [3]甘肃中医药大学临床医学院,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2020年第5期1-7,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：兰州市科技发展计划项目(2017-ZD-43);2018年甘肃中医药大学研究生创新基金资助项目(2019CX27)。

摘　　要：目的系统评价经导管动脉栓塞化疗(TACE)联合门静脉支架及^125Ⅰ粒子植入治疗肝细胞肝癌(HCC)合并门静脉癌栓(PVTT)的有效性和安全性。方法检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国知识基础设施工程及万方数据库,并检索相关文献中的参考文献。检索时限自建库至2019年9月。2名评价员独立进行文献筛选、资料提取,并评价文献质量。采用Stata 12.0软件进行Meta分析。结果共纳入8项研究1005名患者。汇总结果显示,TACE联合门静脉支架及^125Ⅰ粒子植入(试验组)治疗较未联合^125Ⅰ粒子植入(对照组)可明显提高患者术后6个月生存率(OR=3.85,95%CI:[2.62,5.66],P<0.001)、1 a生存率(OR=5.47,95%CI:[3.77,7.93],P<0.001)及6个月支架通畅率(OR=3.78,95%CI:[1.66,8.64],P=0.002)、1 a支架通畅率(OR=4.99,95%CI:[3.60,6.93],P<0.001)。但2种治疗方案之间肝内肿瘤的客观缓解率差异无统计学意义(OR=1.40,95%CI:[0.96,2.03],P=0.085)。2组治疗方案间消化道出血的发生率,试验组低于对照组(OR=0.47,95%CI:[0.22,0.99],P=0.047),其他常见并发症(如发热,肝功能异常、粒细胞减少等)差异无统计学意义(P>0.05)。结论TACE联合门脉支架及^125Ⅰ粒子植入治疗HCC合并PVTT安全、有效,可明显提高患者的生存率,延长支架通畅时间。Objective To systematically evaluate the effectiveness and safety of transcatheter arterial chemoembolization(TACE)combined with portal vein stenting and iodine-^125 brachytherapy in patients with hepatocellular carcinoma(HCC)combined with portal vein tumor thrombus(PVTT).Methods The PubMed,Embase,Cochrane Library,China Biology Medicine Disc,China National Knowledge Infrastructure and Wan fang Data were searched,and searched for references included in the literature.The time limit for searching was from the establishment of the database to September 2019.Two reviewers independently performed literature screening,data extraction,and evaluation of literature quality.Statistical software Stata12.0 was used in Meta-analysis.Results 8 studies with a total of 1005 patients were included in Meta-analysis.The pooled results showed that TACE with portal vein stenting and iodine-^125 brachytherapy significantly increased the 6-month survival rate(OR=3.85,95%CI:[2.62,5.66],P<0.001),1-year survival rate(OR=5.47,95%CI:[3.77,7.93],P<0.001),6-month stent patency rate(OR=3.78,95%CI:[1.66,8.64],P=0.002)and 1-year stent patency rate(OR=4.99,95%CI:[3.60,6.93],P<0.001)than TACE with portal vein stenting in patients with HCC combined with PVTT.While it did not affect the objective response rate of primary liver tumor(OR=1.40,95%CI:[0.96,2.03],P=0.085).The incidence of gastrointestinal bleeding was lower in the experimental group than in the control group(OR=0.47,95%CI:[0.22,0.99],P=0.047).While other common complications such as fever,abnormal liver function,and neutropenia were not statistically significant(P>0.05).Conclusion TACE with portal vein stenting and intravascular brachytherapy is effective and safe in patients with HCC combined with PVTT,which can significantly improved the survival rate and extend the stent patency period.

关 键 词：门脉癌栓 ^125Ⅰ 门脉支架 META分析 

分 类 号：R735.7[医药卫生—肿瘤]