Yang De-Jun, Luo Kun-Lun, Liu Hong, Cai Bing, Tao Guo-Qing, Su Xiao-Fang, Hou Xiao-Juan, Ye Fei, Li Xiang-Yong, Tian Zhi-Qiang
Department of Gastrointestinal Surgery, The Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
Department of General Surgery and Rehabilitation Medicine and Oncology, The 101st Hospital of Chinese PLA, Wuxi 214044, China.
Oncotarget. 2017 Jan 10;8(2):2960-2970. doi: 10.18632/oncotarget.13813.
This meta-analysis was conducted to compare transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with TACE alone for hepatocellular carcinoma. We searched MEDLINE, EMBASE and CENTRAL for all relative randomized controlled trials (RCTs) and retrospective studies until October 31 2016. Tumor response, recurrence-free survival, overall survival and postoperative complications were the major evaluation indices. Review Manager (version 5.3) was used to analyze the data. Dichotomous data was calculated by odds ratio (OR) with 95% confidence intervals (CI). There were 1 RCT and 10 retrospective studies with 928 patients in this meta-analysis: 412 patients with TACE plus RFA and 516 patients with TACE alone. Compared with TACE alone group, TACE plus RFA group attained higher tumor response rates (OR = 6.08, 95% CI = 4.00 to 9.26, P < 0.00001), achieved longer recurrence-free survival rates (ORRFS = 3.78, 95% CI: 2.38 to 6.02, P < 0.00001) and overall survival rates (OR1-year = 3.92, 95% CI = 2.41-6.39, P < 0.00001; OR3-year = 2.56; 95% CI = 1.81-3.60; P < 0.00001; OR5-year = 2.78; 95% CI = 1.77-4.38; P < 0.0001). Serious postoperative complications were not observed, although complications were higher in TACE plus RFA group than that in TACE alone group (OR = 2.74, 95% CI = 1.07 to 7.07, P = 0.04). In conclusion, the use of TACE plus RFA for intermediate stage hepatocellular carcinoma can attain higher tumor response rates and improve survival rates than TACE alone.
本荟萃分析旨在比较经动脉化疗栓塞术(TACE)联合射频消融术(RFA)与单纯TACE治疗肝细胞癌的疗效。我们检索了MEDLINE、EMBASE和CENTRAL数据库,纳入截至2016年10月31日所有相关的随机对照试验(RCT)和回顾性研究。肿瘤反应、无复发生存率、总生存率和术后并发症是主要评估指标。采用Review Manager(5.3版)进行数据分析。二分数据采用比值比(OR)及95%置信区间(CI)进行计算。本荟萃分析纳入了1项RCT和10项回顾性研究,共928例患者:412例接受TACE联合RFA治疗,516例仅接受TACE治疗。与单纯TACE组相比,TACE联合RFA组获得了更高的肿瘤反应率(OR = 6.08,95%CI = 4.00至9.26,P < 0.00001),更长的无复发生存率(ORRFS = 3.78,95%CI:2.38至6.02,P < 0.00001)和总生存率(OR1年 = 3.92,95%CI = 2.41 - 6.39,P < 0.00001;OR3年 = 2.56;95%CI = 1.81 - 3.60;P < 0.00001;OR5年 = 2.78;95%CI = 1.77 - 4.38;P < 0.0001)。虽然TACE联合RFA组并发症高于单纯TACE组(OR = 2.74,95%CI = 1.07至7.07,P = 0.04),但未观察到严重术后并发症。总之,对于中期肝细胞癌,使用TACE联合RFA比单纯TACE可获得更高的肿瘤反应率并提高生存率。