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中国人群肝癌切除术后肝动脉化疗栓塞治疗效果的Meta分析

雷君, 樊玉祥, 何文婷, 曾凡业, 孙奇, 张洪亮

雷君, 樊玉祥, 何文婷, 曾凡业, 孙奇, 张洪亮. 中国人群肝癌切除术后肝动脉化疗栓塞治疗效果的Meta分析[J]. 循证医学, 2015, 15(3): 168-176. DOI: 10.3969/j.issn.1671-5144.2015.03.013
引用本文: 雷君, 樊玉祥, 何文婷, 曾凡业, 孙奇, 张洪亮. 中国人群肝癌切除术后肝动脉化疗栓塞治疗效果的Meta分析[J]. 循证医学, 2015, 15(3): 168-176. DOI: 10.3969/j.issn.1671-5144.2015.03.013
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LEI Jun, FAN Yu-xiang, HE Wen-ting, ZENG Fang-ye, SUN Qi, ZHANG Hong-liang. Meta Analysis of the Combination of TACE and Resection for Treatment of HCC in Chinese[J]. Journal of Evidence-Based Medicine, 2015, 15(3): 168-176. DOI: 10.3969/j.issn.1671-5144.2015.03.013
Citation: LEI Jun, FAN Yu-xiang, HE Wen-ting, ZENG Fang-ye, SUN Qi, ZHANG Hong-liang. Meta Analysis of the Combination of TACE and Resection for Treatment of HCC in Chinese[J]. Journal of Evidence-Based Medicine, 2015, 15(3): 168-176. DOI: 10.3969/j.issn.1671-5144.2015.03.013
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中国人群肝癌切除术后肝动脉化疗栓塞治疗效果的Meta分析

  • 新疆医科大学附属中医医院 a. 肿瘤科, 乌鲁木齐 830000; b. 医学研究设计与数据处理中心, 乌鲁木齐 830000

基金项目: 新疆医科大学科研创新基金资助项目（XJC201195）
详细信息
    作者简介:

    雷君（1972-）,女,乌鲁木齐人,副主任医师,硕士研究生,主要从事肿瘤免疫治疗研究。

    通讯作者:

    张洪亮, Tel: 0991-5850416, E-mail: zhl8625@sina.com

  • 中图分类号: R735.7

Meta Analysis of the Combination of TACE and Resection for Treatment of HCC in Chinese

  • a. Department of Oncology; b. Medical Statistics and Data Processing Center, The Affiliated Traditional Chinese Medical Hospital, Xinjiang Medical University, Urumqi 830000, China

摘要

    摘要
  • 摘要: 目的 系统评价中国人群原发性肝癌（HCC）切除术后辅助肝动脉化疗栓塞（TACE） 治疗肝癌的效果。 方法 计算机检索PubMed,Cochrane 图书馆、Web of Knowledge、中国生物医学文献数据库、中国期刊全文数据库和重庆维普数据库中自建库至2014年9月1日公开发表的关于中国人群肝癌术后TACE治疗的随机对照试验。应用RevMan5.0软件进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型进行数据合并,计算合并风险比及其95%可信区间并对分析结果进行敏感性分析,采用绘制漏斗图法评估发表偏倚。结果共纳入14项研究共计1 029例患者,其中行手术+TACE患者467例,单纯手术治疗患者462例。通过Jadad量表进行评价。经Meta分析,HCC术后行TACE 治疗较单纯手术治疗能有效降低患者术后1年、2年和3年复发率,风险比及其95%可信区间分别为0.48（0.37~0.63）、0.62（0.50~0.77）和0.62（0.45~0.84）;HCC术后行TACE 治疗较单纯手术治疗能有效提高患者术后1年、2年和3年总生存率,风险比及其95%可信区间分别为1.37（1.23~1.54）、1.66（1.36~2.04）和2.05（1.51~2.77）,两组的术后无病生存率差异无统计学意义。发热、恶心、呕吐及肝功能异常是术后 TACE 最常见的不良反应。 结论 在中国人群中,与单纯HCC切除术相比,术后辅助TACE治疗能有效降低患者术后复发率、提高总生存率,但尚不能认为其对术后无病生存率有所影响,尚需更多设计严格、随访时间足够长的大样本随机对照试验来验证。
    Abstract: Objective To evaluate the transarterial chemoembolization（TACE） in preventing recurrence and improving Chinese patient’s survival after curative resection for hepatocellular carcinoma （HCC） by using a meta-analysis. Methods Relevant randomized controlled trials （RCTs）related to TACE treatment after HCC resection were searched using PubMed, Cochrane Library, ISI Web of Knowledge, CBM, CNKI and VIP from inception to September 2014. RevMan5.0 was applied for the meta-analysis. After heterogeneity analysis, pooled risk ratio （RR） with 95% confidence interval （95%CI） using both fixed and random effect models were estimated. Sensitivity analyses were used for evaluating the robustness of the result. Publication bias was assessed by map funnel method. Results A total of 14 RCTs involving 1 029 patients were included, 467 cases of patients with hepatectomy plus TACE, 462 patients with hepatectomy alone. All were evaluated by the Jadad scale, 4 items of high quality research, 10 low quality research. Compared with hepatectomy only, the RR （95%CI） of the recurrence at 1, 2 and 3 years after the resection in case group were 0.48 （95%CI 0.37~0.63）, 0.62（0.50~0.77） and 0.50 （0.45~0.84）, which all had statistic significance reflecting that postoperative adjuvant TACE could reduce recurrence rate. Postoperative adjuvant TACE seems to improve the overall survival （OS） rate for 1 year, 2 years and 3 years than hepatectomy only, RR and 95%CI: 1.37 （1.23~1.54）, 1.66（1.36~2.04） and 1.36 （1.51~2.77）, But the differences of disease-free survival （DFS） rate between the two groups were not significance. Side effects and severe adverse events related with TACE were mainly liver function impairment, fever and gastrointestinal symptoms. Conclusions Based on the results of this meta analysis, postoperative adjuvant TACE could reduce the recurrence rate and improve the OS of HCC, but may not DFS of patients. However, more RCTs with high quality are still needed to assess and verify the efficacy and safety further.
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  • 收稿日期:  2014-11-17
  • 发布日期:  2015-06-29

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