Jia J B, Zhang D, Ludwig J M, Kim H S
Department of Radiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, Los Angeles, CA, 90027, USA.
Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA.
Clin Radiol. 2017 Dec;72(12):1066-1075. doi: 10.1016/j.crad.2017.07.024. Epub 2017 Aug 26.
To evaluate whether radiofrequency ablation (RFA) or surgical resection (RES) has superior overall survival (OS) and disease-free survival (DFS) in patients with hepatocellular carcinoma and Child-Pugh class A liver cirrhosis.
Meta-analysis was used to compare 1-, 3-, and 5-year OS and DFS between RFA and RES. Those studies meeting inclusion criteria and published prior to 1 June 2015 were included. The odds ratio (OR) was used as the treatment effect measure. A priori defined sensitivity analyses of study subgroups was performed.
Fifteen studies were included in this analysis. Subgroup analyses based on predetermined patient characteristics were performed to minimise bias. No difference in 1-year OS, 3-year OS, and 3-year DFS was found in analyses limited to studies where patients were equally eligible for both therapies. There was also not a significant difference in OS and DFS between RFA and RES when studies were limited to those with only solitary tumours or tumours <3 cm.
The data suggest the equivalence of RFA and RES in patients with solitary tumours <3 cm and good liver status based on Child-Pugh score.
评估在肝细胞癌合并Child-Pugh A级肝硬化患者中，射频消融（RFA）或手术切除（RES）是否具有更优的总生存期（OS）和无病生存期（DFS）。
采用荟萃分析比较RFA和RES之间的1年、3年和5年OS及DFS。纳入符合纳入标准且在2015年6月1日前发表的研究。采用比值比（OR）作为治疗效果衡量指标。对研究亚组进行预先定义的敏感性分析。
本分析纳入了15项研究。基于预先确定的患者特征进行亚组分析以尽量减少偏倚。在仅限于患者对两种治疗均同样适用的研究分析中，未发现1年OS、3年OS和3年DFS存在差异。当研究仅限于仅有孤立肿瘤或肿瘤<3 cm的患者时，RFA和RES之间的OS和DFS也无显著差异。
数据表明，对于肿瘤<3 cm的孤立性肿瘤且基于Child-Pugh评分肝脏状况良好的患者，RFA和RES疗效相当。
