The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery, Royal Free Hospital, Pond Street, London, UK.
J Hepatol. 2010 Mar;52(3):380-8. doi: 10.1016/j.jhep.2009.12.004. Epub 2010 Jan 17.
BACKGROUND & AIMS: Radiofrequency ablation (RFA) is often the preferred local ablation therapy for hepatocellular carcinoma (HCC). Percutaneous ethanol injection (PEI) is less frequently used, and percutaneous acetic acid injection (PAI) has been mostly abandoned. Robust evidence showing benefit of one therapy versus another is lacking. Our aim was to evaluate the evidence comparing RFA, PEI and PAI using meta-analytical techniques.
Literature search was undertaken until December 2008 to identify comparative studies evaluating survival, recurrence, complete necrosis of tumour and complications. Only randomized clinical trials and quasi-randomized studies were included. Adjusted indirect comparisons were made when direct comparative studies were insufficient.
Eight studies were identified: RFA vs. PEI (n=5), PAI vs. PEI (n=2) and RFA vs. PAI vs. PEI (n=1) including 1035 patients with nine comparisons. RFA was superior to PEI for survival (OR 0.52; 95% CI 0.35-0.78; p=0.001), complete necrosis of tumour and local recurrence. For tumours 2 cm RFA was not significantly better than PEI. PAI did not differ significantly from PEI for survival (OR 0.55; 95% CI 0.23-1.33; p=0.18), and local recurrence but required less sessions. PAI had similar outcomes, except local recurrence, to RFA in the direct and indirect comparison.
RFA seems to be a superior ablative therapy than PEI for HCC, particularly for tumours >2 cm. PAI did not differ significantly from PEI for all the outcomes evaluated. RFA and PAI have similar survival rates. For tumours 2 cm outcome benefits comparing RFA and PEI are similar. PAI needs re-evaluation versus both PEI and RFA for tumours 2 cm.
射频消融（RFA）通常是治疗肝细胞癌（HCC）的首选局部消融疗法。经皮乙醇注射（PEI）的应用较少，而经皮醋酸注射（PAI）已基本废弃。目前缺乏关于这两种疗法孰优孰劣的有力证据。本研究旨在使用荟萃分析技术评估比较 RFA、PEI 和 PAI 的证据。
检索截至 2008 年 12 月的文献，以确定评价生存、复发、肿瘤完全坏死和并发症的比较性研究。仅纳入随机临床试验和准随机研究。当直接比较研究不足时，进行调整的间接比较。
共确定 8 项研究：RFA 与 PEI（n=5）、PAI 与 PEI（n=2）和 RFA、PEI 与 PAI（n=1），共纳入 1035 例患者的 9 项比较。与 PEI 相比，RFA 具有更好的生存（OR 0.52；95%CI 0.35-0.78；p=0.001）、肿瘤完全坏死和局部复发率。对于 2cm 的肿瘤，RFA 并不明显优于 PEI。PAI 在生存（OR 0.55；95%CI 0.23-1.33；p=0.18）和局部复发方面与 PEI 无显著差异，但需要较少的治疗次数。在直接和间接比较中，PAI 的结局与 RFA 相似，除了局部复发。
对于 HCC，RFA 似乎是一种优于 PEI 的消融疗法，尤其是对于＞2cm 的肿瘤。在所有评估的结局中，PAI 与 PEI 无显著差异。RFA 和 PAI 的生存率相似。对于 2cm 的肿瘤，RFA 和 PEI 的疗效相似。需要重新评估 PAI 相对于 PEI 和 RFA 在 2cm 肿瘤中的应用。
