Facciorusso Antonio, Serviddio Gaetano, Muscatiello Nicola
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy.
World J Hepatol. 2016 Jun 28;8(18):770-8. doi: 10.4254/wjh.v8.i18.770.
To compare the efficacy and safety of yttrium-90 radioembolization (Y90RE) and transarterial chemoembolization (TACE) in hepatocellular carcinoma patients.
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.
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).
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.
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。
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。
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）。
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。
