摘要
目的 评价ⅢA与ⅢB期肝癌根治术后预防性行肝动脉栓塞化疗术(transcatheter arterial chemoembolization,TACE)治疗对提高生存获益的疗效及安全性。方法 计算机检索PubMed、Medline、Cochrane图书馆、中国知网、中国生物医学文献数据库和中国期刊全文数据库中的相关文献,中英文不限,收集已发表的研究结果。末次检索时间为2013-11-1。由2名评价员筛选和提取资料,采用Cochrane Handbook for Systematic Review of Intervention进行质量评估,对符合纳入标准的研究采用RevMan 5.2软件进行分析。结果 最终纳入6篇随机对照试验,1篇为国外研究,其余5篇为国内研究,共546名患者。Meta分析结果表明,与对照组相比,术后预防性行TACE治疗可明显降低早期复发率,实验组术后1年复发率为34.6%,相对危险度RR(95%CI)为0.76(0.61~0.96,P=0.02);术后预防性行TACE治疗可以明显降低早期死亡率,实验组术后1和3年死亡率分别为26.7%和60.9%,相对危险度RR(95%CI)分别为0.66(0.52~0.84,P=0.0007)和0.85(0.75~0.97,P=0.02)。然而,5年死亡率差异无统计学意义,RR=0.94,95%CI:0.86~1.03,P=0.18。主要不良反应为发热、恶心呕吐。未发现与术后经TACE治疗相关死亡的报道。结论 ⅢA与ⅢB期肝癌术后预防性行TACE可以显著降低复发率、提高总生存率、改善患者的生存获益。由于本研究纳入病例数较少,无法确定偏倚对结论可靠性的影响程度,仍需更多的随机对照研究进一步评估。
OBJECTIVE To evaluate the efficacy and safety of preventive TACE for patients with stage ⅢA-Ⅲ B HCC. METHODS All randomized controlled trials were electronically searched in database included PubMed, Medline, the Coehrane Library, CBMdisc, CNKI without language limitation. All trials were identified and screened by two reviewers, the qualities of which were evaluated by Cochrane Handbook for Systematic Review of Intervention. The data, extracted from the included randomized controlled trials was analyzed by Cochrane Collaboration's RevMan5.2 software. RESULTS Six RCTs including 546 participants, of whom all were of stage ⅢA-ⅢB Hepatocellnlar Carcinoma (HCC) were enrolled. Meta-analysis of data indicated that hepatectomy combined with postoperative TACE showed statistically significant in less incidence of early recurrence at 1 year (34.6%, RR = 0.76, 95% CI = 0.61- 0.96, P = 0.02), which could also significantly reduce early mortality at 1,3year respectively ( 26. 7%, RR = 0. 66, 95% CI=0. 52 -0. 84, P = 0. 000 7 ; 60.9%, RR= 0.85, 95% CI = 0.75- 0.97, P = 0.02). However, for 5year mortality, the combined treatment group did not reveal statistically significant less incidenee(RR= 0.94, 95%CI= 0.86-1.03, P= 0. 18 ). Transient fever and nausea/vomiting were mostly reported as side effects of TACE but were well tolerated by most patients. CONCLUSION Postoperative TACE seems promising for the benefit in terms of recurrence and mortality for participants with stage ⅢA-ⅢB HCC but requires further trials.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2015年第1期66-71,共6页
Chinese Journal of Cancer Prevention and Treatment
关键词
肝肿瘤
肿瘤分期
肝癌术后
肝动脉栓塞化疗
复发
总生存率
META分析
liver neoplasms
neoplasms staging
hepatectomy
transcatheter arterial cbemoembolization
recurrence
overall survival rate
Meta analysis