经动脉放射性栓塞术与化疗栓塞术治疗肝癌患者的比较：一项系统评价和荟萃分析。
Transarterial radioembolization vs chemoembolization for hepatocarcinoma patients: A systematic review and meta-analysis.
作者信息
Facciorusso Antonio, Serviddio Gaetano, Muscatiello Nicola
机构信息
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
出版信息
World J Hepatol. 2016 Jun 28;8(18):770-8. doi: 10.4254/wjh.v8.i18.770.
AIM
To compare the efficacy and safety of yttrium-90 radioembolization (Y90RE) and transarterial chemoembolization (TACE) in hepatocellular carcinoma patients.
METHODS
Bibliographic research was conducted on main scientific databases. When there was no statistically significant heterogeneity, pooled effects were calculated using a fixed-effects model by means of Mantel-Haenszel test, otherwise, a random-effects model was used with DerSimonian and Laird test. Summary estimates were expressed in terms of odds ratios (ORs) and 95%CI. The probability of publication bias was assessed using funnel plots and with Begg and Mazumdar's test. Sensitivity analysis was finally conducted using the method of excluding extreme data.
RESULTS
A total of 10 studies were analyzed, of which 2 randomized controlled trials. Survival rate (SR) assessed at 1 year showed an absolute similarity between the two treatment groups (OR = 1.01, 95%CI: 0.78-1.31, P = 0.93). As long as time elapsed since the treatment, ORs for survival rate tended to significantly increase, thus meaning better long-term outcomes in patients who underwent Y90RE (2-year SR: OR = 1.43, 1.08-1.89, P = 0.01; 3-year SR: OR = 1.48, 1.03-2.13, P = 0.04). Meta-analysis of plotted hazard ratios (HRs) determined a non-significant overall estimate in favor of Y90RE (HR = 0.91, 0.80-1.04, P = 0.16). Y90RE showed a statistically significant benefit as compared to TACE in terms of higher progression-free survival rate assessed at 1 year (OR = 1.67; 95%CI: 1.10-2.55; P = 0.02). Pooled analyses do not revealed a statistically significant increase in OR for tumor objective responses after Y90RE with respect to TACE (OR = 1.22, 95%CI: 0.69-2.16, P = 0.50). A non-significant trend in favor of Y90RE was observed according to adverse event rate (OR = 0.70, 0.38-1.30, P = 0.26).
CONCLUSION
Our meta-analysis reveals that Y90RE and TACE show similar effects in terms of survival, response rate and safety profile, although tumor progression is delayed after radioembolization.
目的
比较钇-90放射性栓塞（Y90RE）与经动脉化疗栓塞（TACE）治疗肝细胞癌患者的疗效和安全性。
方法
在主要科学数据库进行文献研究。当不存在统计学显著异质性时，采用Mantel-Haenszel检验的固定效应模型计算合并效应，否则，采用DerSimonian和Laird检验的随机效应模型。汇总估计以比值比（OR）和95%置信区间表示。使用漏斗图以及Begg和Mazumdar检验评估发表偏倚的概率。最后采用排除极端数据的方法进行敏感性分析。
结果
共分析了10项研究，其中2项为随机对照试验。1年时评估的生存率（SR）显示两个治疗组之间绝对相似（OR = 1.01，95%CI：0.78 - 1.31，P = 0.93）。随着治疗后时间的推移，生存率的OR值倾向于显著增加，这意味着接受Y90RE治疗的患者长期预后更好（2年SR：OR = 1.43，1.08 - 1.89，P = 0.01；3年SR：OR = 1.48，1.03 - 2.13，P = 0.04）。绘制的风险比（HR）的荟萃分析确定总体估计无显著差异，倾向于Y90RE（HR = 0.91，0.80 - 1.04，P = 0.16）。与TACE相比，Y90RE在1年时评估的无进展生存率更高方面显示出统计学显著益处（OR = 1.67；95%CI：1.10 - 2.55；P = 0.02）。汇总分析未显示Y90RE相对于TACE后肿瘤客观反应的OR有统计学显著增加（OR = 1.22，95%CI：0.69 - 2.16，P = 0.50）。根据不良事件发生率观察到有利于Y90RE的无显著趋势（OR = 0.70，0.38 - 1.30，P = 0.26）。
结论
我们的荟萃分析表明，Y90RE和TACE在生存率、缓解率和安全性方面显示出相似的效果，尽管放射性栓塞后肿瘤进展有所延迟。
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