肝细胞癌中传统经动脉化疗栓塞术与微球栓塞术的比较：一项荟萃分析
Conventional transarterial chemoembolization vs microsphere embolization in hepatocellular carcinoma: a meta-analysis.
作者信息
Ni Jia-Yan, Xu Lin-Feng, Wang Wei-Dong, Sun Hong-Liang, Chen Yao-Ting
机构信息
Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
出版信息
World J Gastroenterol. 2014 Dec 7;20(45):17206-17. doi: 10.3748/wjg.v20.i45.17206.
AIM
To compare conventional transarterial chemoembolization (c-TACE) with microsphere embolization in hepatocellular carcinoma (HCC).
METHODS
We searched PubMed, Medline, Embase and the Cochrane Library for trials assessing the efficacy and safety of c-TACE in comparison with those of yttrium-90 microsphere or drug-eluting bead embolization from January 2004 to December 2013. Overall survival rate (OSR), tumor response [complete response, partial response (PR), stable disease (SD), progressive disease (PD)], α-fetoprotein (AFP) response, progression rate and complications were compared and analyzed. Pooled ORs with 95%CI were calculated using either the fixed-effects model or random-effects model. All statistical analyses were conducted using the Review Manager (version 5.1.) from the Cochrane collaboration.
RESULTS
Thirteen trials were identified, including a total of 1834 patients; 1233 were treated with c-TACE, 377 underwent yttrium-90 microsphere embolization and 224 underwent drug-eluting bead embolization. The meta-analysis with either the random-effects model or fixed-effects model indicated that microsphere embolization was associated with significantly higher OSRs compared with those of c-TACE (OR(1-year) = 1.38, 95%CI(1-year): 1.05-1.82; OR(2-year) = 2.88, 95%CI(2-year): 1.18-7.05; OR(3-year) = 2.15, 95%CI(3-year): 1.18-3.91). The complete tumor response rates of patients who underwent microspheres embolization were significantly higher than those of patients treated with c-TACE (OR = 2.19, 95%CI: 1.31-3.64). The tumor progression rate after microsphere embolization was markedly lower than that after c-TACE (OR = 0.56, 95%CI: 0.39-0.81). There was no significant difference between microsphere embolization and c-TACE in PR (OR = 0.73, 95%CI: 0.47-1.15), SD (OR = 1.07, 95%CI: 0.79-1.44), PD (OR = 0.75, 95%CI: 0.33-1.68), AFP response (OR = 1.38, 95%CI: 0.64-2.94) and complications (OR = 0.68, 95%CI: 0.46-1.00).
CONCLUSION
Our analysis indicated that microsphere embolization was associated with superior survival and treatment response in comparison with c-TACE in the treatment of patients with HCC.
目的
比较传统经动脉化疗栓塞术（c-TACE）与微球栓塞术治疗肝细胞癌（HCC）的效果。
方法
我们检索了PubMed、Medline、Embase和Cochrane图书馆，查找2004年1月至2013年12月期间评估c-TACE与钇-90微球或载药微球栓塞术疗效和安全性的试验。比较并分析总生存率（OSR）、肿瘤反应[完全缓解、部分缓解（PR）、疾病稳定（SD）、疾病进展（PD）]、甲胎蛋白（AFP）反应、进展率和并发症。使用固定效应模型或随机效应模型计算合并的OR值及95%置信区间（CI）。所有统计分析均使用Cochrane协作网的Review Manager（版本5.1）进行。
结果
共纳入13项试验，总计1834例患者；1233例接受c-TACE治疗，377例接受钇-90微球栓塞术，224例接受载药微球栓塞术。随机效应模型或固定效应模型的荟萃分析表明，与c-TACE相比，微球栓塞术的OSR显著更高（OR（1年）=1.38，95%CI（第1年）：1.05 - 1.82；OR（2年）=2.88，95%CI（第2年）：1.18 - 7.05；OR（3年）=2.15，95%CI（第3年）：1.18 - 3.91）。接受微球栓塞术患者的肿瘤完全缓解率显著高于接受c-TACE治疗的患者（OR = 2.19，95%CI：1.31 - 3.64）。微球栓塞术后的肿瘤进展率明显低于c-TACE术后（OR = 0.56，95%CI：0.39 - 0.81）。微球栓塞术与c-TACE在PR（OR = 0.73，95%CI：0.47 - 1.15）、SD（OR = 1.07，95%CI：0.79 - 1.44）、PD（OR = 0.75，95%CI：0.33 - 1.68）、AFP反应（OR = 1.38，95%CI：0.64 - 2.94）和并发症（OR = 0.68，95%CI：0.46 - 1.00）方面无显著差异。
结论
我们的分析表明，在治疗HCC患者时，与c-TACE相比，微球栓塞术具有更好的生存率和治疗反应。
Zotero 插件