伴门静脉癌栓的晚期肝细胞癌动脉内化疗栓塞联合与不联合放射治疗的比较：一项荟萃分析

Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis.

作者信息

Zhao Qianqian, Zhu Kunli, Yue Jinbo, Qi Zhonghua, Jiang Shumei, Xu Xiaoqing, Feng Rui, Wang Renben

机构信息

School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.

Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of China.

出版信息

Ther Clin Risk Manag. 2016 Dec 22;13:21-31. doi: 10.2147/TCRM.S126181. eCollection 2017.

PURPOSE

Numerous studies have tried to combine transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) with radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT.

METHODS

PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR), overall survival (OS), and adverse events.

RESULTS

Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07-5.80; <0.001) and OS (HR, 0.69; 95% CI, 0.57-0.83; =0.001), but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67-2.79; =0.390). The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478-13.56; <0.001) and thrombocytopenia (OR, 3.77; 95% CI, 1.06-13.43; =0.041) was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group.

CONCLUSION

Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could bring higher ORR of PVTT and better survival benefits. This combination therapy was also associated with a significantly increased risk of adverse events. However, they were mostly mild to moderate and successfully treated with conservative treatment.

目的

众多研究试图将经动脉化疗栓塞术（TACE）或肝动脉灌注化疗（HAIC）与放射治疗（RT）相结合，用于治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）患者。然而，TACE或HAIC联合RT与单独使用TACE或HAIC的疗效仍存在争议。因此，我们进行了一项荟萃分析，以比较动脉内化疗栓塞联合RT与单纯动脉内化疗栓塞治疗伴有PVTT的HCC患者的疗效和安全性。

方法

系统检索PubMed、Embase和Cochrane图书馆数据库中的合格研究。两位作者独立审查摘要，提取相关数据并评估研究质量。主要终点为客观缓解率（ORR）、总生存期（OS）和不良事件。

结果

本荟萃分析纳入了8项研究，共1760例患者。汇总结果显示，动脉内化疗栓塞联合RT显著提高了PVTT的ORR（OR，4.22；95%CI，3.07 - 5.80；<0.001）和OS（HR，0.69；95%CI，0.57 - 0.83；=0.001），但不影响原发性肝癌的ORR（OR，1.37；95%CI，0.67 - 2.79；=0.390）。动脉内化疗栓塞加RT组3级或4级白细胞减少症（OR，5.80；95%CI，2.478 - 13.56；<0.001）和血小板减少症（OR，3.77；95%CI，1.06 - 13.43；=0.041）的发生率高于动脉内化疗栓塞组。