Dong Wei, Zhang Ting, Wang Zhen-Guang, Liu Hui
Wei Dong, Ting Zhang, Zhen-Guang Wang, Hui Liu, the Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
World J Gastroenterol. 2014 Aug 7;20(29):10174-82. doi: 10.3748/wjg.v20.i29.10174.
To compare clinical outcomes between surgical resection (RES) and nonsurgical-RES (nRES) ablation therapies for small hepatocellular carcinoma (HCC).
MEDLINE, Embase and Cochrane Library databases were systematically searched for studies of RES and nRES treatments for small HCC between January 2003 and October 2013. The clinical outcome measures evaluated included overall survival rate, disease-free survival rate, adverse events, and local recurrence rate. Odds ratios (ORs) with 95%CIs were calculated using either the fixed effects model or random effects model. The χ(2) and I(2) tests were calculated to assess the heterogeneity of the data. Funnel plots were used to assess the risk of publication bias.
Our analysis included 12 studies that consisted of a total of 1952 patients (RES vs nRES), five studies that consisted of 701 patients [radiofrequency ablation (RFA) vs percutaneous ethanol injection (PEI)], and five additional studies [RFA vs RFA + transcatheter arterial chemoembolization (TACE)] that all addressed the treatment of small HCC. For cases of RES vs nRES, there was no significant difference in the 1-year (OR = 0.99, 95%CI: 0.87-1.12, P = 0.85) or 3-year (OR = 0.97, 95%CI: 0.84-1.11, P = 0.98) overall survival rate; however, there was a significant increase in the RES group in the 5-year overall survival rate (OR = 0.81, 95%CI: 0.68-0.95, P = 0.01). The 1-year (OR = 0.94, 95%CI: 0.82-1.08, P = 0.37) and 5-year (OR = 0.99, 95%CI: 0.85-1.14, P = 0.85) disease-free survival rates showed no significant differences between the two groups. The 3-year disease-free survival rate (OR = 0.81, 95%CI: 0.69-0.96; P = 0.02) was higher in the RES group. For cases of RFA vs PEI, our data analysis indicated that RFA treatment was associated with significantly higher 2-year (OR = 0.76, 95%CI: 0.58-0.99, P = 0.043) and 3-year (OR = 0.73, 95%CI: 0.54-0.98, P = 0.039) overall survival rates; however, there were no significant differences in the 1-year (OR = 0.92, 95%CI: 0.72-1.17, P = 0.0502) overall survival rate or incidence of adverse events (OR = 1.84, 95%CI: 0.76-4.45, P = 0.173). For cases of RFA vs RFA+TACE, there were no significant differences in the 1-year (OR = 1.17, 95%CI: 0.88-1.56, P = 0.27) or 3-year (OR = 1.25, 95%CI: 0.90-1.73, P = 0.183) overall survival rate; however, the 5-year overall survival rate (OR = 3.19, 95%CI: 1.51-6.74, P = 0.002) in patients treated by RFA+TACE was higher than that treated by RFA alone.
Surgical resection is superior to nonsurgical ablation for the treatment of small HCC. Among the studies analyzed, RFA is the most efficacious single nonsurgical ablation treatment.
比较手术切除（RES）与非手术性RES（nRES）消融疗法治疗小肝细胞癌（HCC）的临床疗效。
系统检索MEDLINE、Embase和Cochrane图书馆数据库中2003年1月至2013年10月期间关于小HCC的RES和nRES治疗的研究。评估的临床结局指标包括总生存率、无病生存率、不良事件和局部复发率。采用固定效应模型或随机效应模型计算95%置信区间的比值比（OR）。计算χ(2)和I(2)检验以评估数据的异质性。采用漏斗图评估发表偏倚风险。
我们的分析纳入了12项研究，共1952例患者（RES组与nRES组），5项研究共701例患者[射频消融（RFA）与经皮乙醇注射（PEI）]，以及另外5项研究[RFA与RFA + 经动脉化疗栓塞术（TACE）]，所有这些研究均涉及小HCC的治疗。对于RES组与nRES组的病例，1年（OR = 0.99，95%CI：0.87 - 1.12，P = 0.85）或3年（OR = 0.97，95%CI：0.84 - 1.11，P = 0.98）总生存率无显著差异；然而，RES组的5年总生存率显著提高（OR = 0.81，95%CI：0.68 - 0.95，P = 0.01）。两组间1年（OR = 0.94，95%CI：0.82 - 1.08，P = 0.37）和5年（OR = 0.99，95%CI：0.85 - 1.14，P = 0.85）无病生存率无显著差异。RES组的3年无病生存率（OR = 0.81，95%CI：0.69 - 0.96；P = 0.02）更高。对于RFA组与PEI组的病例，我们的数据分析表明，RFA治疗与显著更高的2年（OR = 0.76，95%CI：0.58 - 0.99，P = 0.043）和3年（OR = 0.73，95%CI：0.54 - 0.98，P = 0.039）总生存率相关；然而，1年总生存率（OR = 0.92，95%CI：0.72 - 1.17，P = 0.0502）或不良事件发生率（OR = 1.84，95%CI：0.76 - 4.45，P = 0.173）无显著差异。对于RFA组与RFA + TACE组的病例，1年（OR = 1.17，95%CI：0.88 - 1.56，P = 0.27）或3年（OR = 1.25，95%CI：0.90 - 1.73，P = 0.183）总生存率无显著差异；然而，接受RFA + TACE治疗的患者的5年总生存率（OR = 3.19，95%CI：1.51 - 6.74，P = 0.002）高于单纯接受RFA治疗的患者。
手术切除在治疗小HCC方面优于非手术消融。在分析的研究中，RFA是最有效的单一非手术消融治疗方法。
