摘要
目的:评价肝癌术后早期经肝动脉化疗栓塞对预防复发及提高总生存率的疗效和安全性。方法:计算机检索Med-line、Embase、Cochrane图书馆和中国生物医学文献数据库、中国期刊全文数据库和万方数据库中的相关文献,语种不限,所有检索均截止至2007年10月10日。检索所有有关肝癌术后经肝动脉化疗栓塞的随机对照试验,由2名评价员筛选和提取资料,并用改良后的Jadad量表进行质量评估,对符合纳入标准的研究采用RevMan4.2软件进行分析。结果:共纳入9个随机对照试验,6篇中文,3篇英文,总共586例。Meta分析结果显示:与单用手术治疗肝癌组相比,术后早期经肝动脉化疗栓塞可以明显降低复发率:术后6个月、1、3、5年复发率的相对危险度RR(95%CI)分别为0.38(0.23～0.62)、0.61(0.41～0.90)、0.63(0.50～0.80)、0.74(0.60～0.90);术后早期经肝动脉化疗栓塞可以明显提高术后的总生存率:1、2、3、5年总生存率的RR值(95%CI)分别为1.27(1.15～1.40)、1.52(1.25～1.85)、1.60(1.27～2.02)、1.78(1.09～2.90)。有3篇研究报道了与术后经肝动脉化疗栓塞治疗相关的不良反应,主要为轻中度的肝功能损害,消化道反应和暂时性发热,没有与术后经肝动脉化疗栓塞治疗相关死亡的报道。结论:现有证据显示肝癌术后早期经肝动脉化疗栓塞可以显著降低复发率,提高总生存率,尤其是大肝癌且伴有肝炎肝硬化、肉眼可见癌栓、无包膜或包膜不完整等复发高危因素的患者。但由于纳入的研究多数方法学质量较低,尚需更多更高质量的临床随机对照试验进一步评估证实其疗效和安全性。
Objective：To evaluate the efficacy and safety of early postoperative transcatheter arterial chemoembolization in preventing recurrence of primary liver cancer and improving patients＇ survival. Methods：Medline（1966-October 2007）,Embase（1974-October 2007）,the Cochrane Library（Issue 4,2007）,CBMdisc（1978-October 2007）,CNKI（1979-October 2007）,Wanfang Database were searched without language limitation. All randomized controlled trials comparing hepatectomy alone with hepatectomy and early postoperative transcatheter arterial chemoembolization for primary liver cancer were identified and screened by two reviewers,and the methodological quality of the included randomized controlled trials were evaluated by Jadad scale. The Cochrane Collaboration＇s RevMan4.2 software was used for analysis of the data extracted from the included randomized controlled trials. Results：Nine randomized controlled trials involving 586 patients were included with 6 trials published in Chinese and 3 in English. Meta-analysis of data extracted from the included randomized controlled trials showed that liver resection combined with early postoperative transcatheter arterial chemoembolization could significantly reduce recurrence rates compared with hepatectomy alone ,with the corresponding relative risk（95%CI） of 0.38（0.23～0.62）、0.61（0.41～0.90）、0.63（0.50～0.80）、0.74（0.60～0.90） at 6 month,1,3,5 year respectively;Meanwhile,early postoperative transcatheter arterial chemoembolization could also significantly improve overall survival,with the corresponding relative risk（95%CI） of 1.27（1.15～1.40）、1.52（1.25～1.85）、1.60（1.27～2.02）、1.78（1.09～2.90） at 1,2,3,5 year respectively. Side effects and severe adverse events related with postoperative transcatheter arterial chemoembolization were reported in 3 randomized controlled trials,mainly of liver function impairment,fever and gastrointestinal symptoms,and no death case related to treatment was reported. Conclusions：Based on the results of this Meta-analysis,early postoperative transcatheter arterial chemoembolization could reduce recurrence of primary liver cancer and improve the patients＇ survival,especially in those with high recurrence risk factors,including large tumor volume with liver cirrhosis and tumor thrombosis. However,the methodological methods of most randomized controlled trials were in low quality,so more randomized controlled trials with high quality are still needed to assess and verify the efficacy and safety further.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2008年第6期726-732,共7页
Journal of Nanjing Medical University(Natural Sciences)
基金
江苏省卫生厅工程资助(135-54)
关键词
原发性肝癌
化疗栓塞
系统评价
primary liver cancer
chemoembolization
systematic review
