微波消融与手术切除治疗肝细胞癌合并肝硬化效果及安全性的Meta分析  

Efficacy and safety of microwave ablation versus hepatic resection in treatment of hepatocellular carcinoma with liver cirrhosis:A Meta-analysis

作　　者：骆建兴[1,2] 张扬[1,2] 向讷 扈晓宇[1,2] LUO Jianxing;ZHANG Yang;XIANG Ne;HU Xiaoyu(Department of Infectious Diseases,The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;School of Clinical Medicine,Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;Department of Traditional Chinese Medicine,Caojiaxiang Community Health Service Center,Chengdu 610081,China)

机构地区：[1]成都中医药大学附属医院感染科,成都610072 [2]成都中医药大学临床医学院,成都610072 [3]成都市金牛区驷马桥曹家巷社区卫生服务中心中医科,成都610081

出　　处：《临床肝胆病杂志》2024年第9期1807-1815,共9页Journal of Clinical Hepatology

基　　金：成都中医药大学附属医院科技基金项目(21YY03)。

摘　　要：目的通过Meta分析系统评价微波消融(MWA)和手术切除(HR)在肝细胞癌(HCC)合并肝硬化中的有效性及安全性。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024509185。检索Pub Med、Cochrane Library、EMBASE、Web of Science、中国知网、维普、万方数据库,时间均为从建库至2023年11月,搜索MWA对比HR治疗HCC合并肝硬化的随机对照试验(RCT)和队列研究,采用Stata 12.0软件进行Meta分析。结果共纳入3项RCT和5项回顾性队列研究,共953例患者。Meta分析显示:MWA的1/2/3/5年总生存率(OS)与HR相比无统计学差异(P值均>0.05)。MWA的1/2/5年复发率与HR相比无统计学差异(P值均>0.05)。MWA的3年复发率高于HR(RR=1.59,95%CI:1.08~2.33,P=0.017)。MWA的1/3/5年无复发生存率(DFS)低于HR(RR=0.94,95%CI:0.89~0.99,P=0.018,I^(2)=0.0%;RR=0.84,95%CI:0.72~0.98,P=0.023,I^(2)=25.4%;RR=0.75,95%CI:0.58~0.98,P=0.032,I^(2)=34.6%)。但亚组分析表明,在RCT组,MWA的1/2/3年OS和1/3年DFS与HR相比无统计学差异(P值均>0.05)。MWA的术中出血量、手术时间、住院时间、不良反应及肝功能均优于HR(SMD=-2.31,95%CI:-2.64~-1.97,P<0.001,I^(2)=3.1%;SMD=-3.38,95%CI:-4.05~-2.71,P<0.001,I^(2)=73.8%;SMD=-2.54,95%CI:-3.27~-1.80,P<0.001,I^(2)=92.8%;RR=0.42,95%CI:0.30~0.59,P<0.001,I^(2)=0.0%;SMD=-1.43,95%CI:-1.89~-0.97,P<0.001)。结论MWA与HR在局部复发、DFS及OS方面无明显差异。MWA术中出血量更少,手术时间更短,不良反应更少,对肝功能影响更小,住院时间更短。Objective To investigate the efficacy and safety of microwave ablation(MWA)versus hepatic resection(HR)in the treatment of hepatocellular carcinoma(HCC)with liver cirrhosis using a meta-analysis.Methods This study was conducted according to the PRISMA guideline,with a PROSPERO registration number of CRD42024509185.PubMed,the Cochrane Library,EMBASE,Web of Science,CNKI,VIP,and Wanfang Data were searched for randomized controlled trials(RCTs)and cohort studies on MWA versus HR in the treatment of HCC with liver cirrhosis published up to November 2023,and Stata 12.0 was used to perform the meta-analysis.Results A total of 3 RCTs and 5 retrospective cohort studies were included,with 953 patients in total.The meta-analysis showed that there were no differences between MWA and HR in 1-,2-,3-,and 5-year overall survival(OS)rates(all P>0.05)and 1-,2-,and 5-year recurrence rates(all P>0.05).Compared with HR,MWA had a significantly higher 3-year recurrence rate(risk ratio[RR]=1.59,95%confidence interval[CI]:1.08—2.33,P=0.017)and significantly lower 1-,3-,and 5-year disease-free survival(DFS)rates(1-year DFS rate:RR=0.94,95%CI:0.89—0.99,P=0.018,I^(2)=0.0%;3-year DFS rate:RR=0.84,95%CI:0.72—0.98,P=0.023,I^(2)=25.4%;5-year DFS rate:RR=0.75,95%CI:0.58—0.98,P=0.032,I^(2)=34.6%).However,subgroup analysis showed that there were no significant differences between MWA and HR in 1-,2-,and 3-year OS rates and 1-and 3-year DFS rates in the RCT subgroup(all P>0.05).Compared with HR,MWA had significantly better intraoperative blood loss(standardized mean difference[SMD]=-2.31,95%CI:-2.64 to-1.97,P<0.001,I^(2)=3.1%),time of operation(SMD=-3.38,95%CI:-4.05 to-2.71,P<0.001,I^(2)=73.8%),length of hospital stay(SMD=-2.54,95%CI:-3.27 to-1.80,P<0.001,I^(2)=92.8%),adverse reactions(RR=0.42,95%CI:0.30—0.59,P<0.001,I^(2)=0.0%),and liver function(SMD=-1.43,95%CI:-1.89—-0.97,P<0.001).Conclusion There are no significant differences between MWA and HR in local recurrence,DFS,and OS,but MWA tends to have a less intraoperative blood loss,a

关 键 词：癌 肝细胞 肝硬化 META分析 

分 类 号：R735.7[医药卫生—肿瘤]