基于肝动脉的治疗方法对不可切除肝内胆管癌的疗效比较
Comparative effectiveness of hepatic artery based therapies for unresectable intrahepatic cholangiocarcinoma.
作者信息
Boehm Lucas M, Jayakrishnan Thejus T, Miura John T, Zacharias Anthony J, Johnston Fabian M, Turaga Kiran K, Gamblin T Clark
机构信息
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
J Surg Oncol. 2015 Feb;111(2):213-20. doi: 10.1002/jso.23781. Epub 2014 Sep 1.
BACKGROUND
Hepatic artery based therapies (HAT) are offered for patients with unresectable intrahepatic cholangiocarcinoma (ICC). We aimed to evaluate the comparative effectiveness of HAT -hepatic arterial infusion (HAI), transcatheter arterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), and Yttrium(90) radioembolization (Y-90) for unresectable ICC.
METHODS
A meta-analysis was performed using a prospectively registered search strategy at PROSPERO (CRD42013004830) that utilized PubMed (2003-2013). Primary outcome was median overall survival (OS), and secondary outcomes were tumor response to therapy and toxicity.
RESULTS
A total of 20 articles (of 793, n=657 patients) were selected for data extraction. Highest Median OS was observed for HAI (22.8, 95% CI 9.8-35.8) months versus Y90 (13.9, 9.5-18.3) months versus TACE (12.4, 10.9-13.9) months versus DEB-TACE (12.3, 11-13.5) months. Response to therapy (complete and partial) was highest for HAI (56.9%, 95%CI 41.0-72.8) versus Y90 (27.4%, 17.4-37.5) versus TACE (17.3%, 6.8-27.8). The grade III/IV toxicity (Events per patient) was highest for HAI (0.35, 95% CI 0.22-0.48) versus TACE (0.26, 0.21-0.32) versus DEB-TACE (0.32, 0.17-0.48).
CONCLUSION
For patients with unresectable ICC treated with HAT, HAI offered the best outcomes in terms of tumor response and survival but may be limited by toxicity.
背景
对于不可切除的肝内胆管癌（ICC）患者，可采用基于肝动脉的治疗方法（HAT）。我们旨在评估HAT（肝动脉灌注[HAI]、经动脉化疗栓塞[TACE]、载药微球TACE[DEB-TACE]和钇-90放射性栓塞[Y-90]）治疗不可切除ICC的相对有效性。
方法
采用前瞻性注册检索策略在PROSPERO（CRD42013004830）进行荟萃分析，该策略利用了PubMed（2003年至2013年）。主要结局为中位总生存期（OS），次要结局为肿瘤对治疗的反应和毒性。
结果
共选择20篇文章（共793篇，n = 657例患者）进行数据提取。观察到HAI的中位OS最高（22.8个月，95%置信区间9.8 - 35.8），其次是Y90（13.9个月，9.5 - 18.3）、TACE（12.4个月，10.9 - 13.9）和DEB-TACE（12.3个月，11 - 13.5）。HAI的治疗反应（完全缓解和部分缓解）最高（56.9%，95%置信区间41.0 - 72.8），其次是Y90（27.4%，17.4 - 37.5）和TACE（17.3%，6.8 - 27.8）。HAI的III/IV级毒性（每位患者的事件数）最高（0.35，95%置信区间0.22 - 0.48），其次是TACE（0.26，0.21 - 0.32）和DEB-TACE（0.32，0.17 - 0.
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