a Liver Cancer Institute, Zhongshan Hospital , Fudan University , Shanghai , China.
b State Key Laboratory of Genetic Engineering , Fudan University , Shanghai , China.
Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):935-945. doi: 10.1080/17474124.2018.1503531. Epub 2018 Jul 25.
Major treatments for small hepatocellular carcinoma (SHCC) include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA), or surgical resection (SR). We aimed to compare these therapies concerning with effectiveness and safety.
Cochrane Library, PubMed, and Embase were searched for randomized controlled studies (RCTs) from inception to 30 April 2017. Odds ratios (OR) for proportion dead (PD), local recurrence (LR) and adverse events (AEs).
Fourteen RCTs were identified. Compared with SR, PEI (OR 2.79, CrI 1.25, 6.45, p < 0.01) provided a significantly increased risk of PD. Similarly, PEI (OR 4.29, CrI 1.18, 18.35, p < 0.01) yielded more LR than SR. Also, SR significantly conferred more AEs than RFA (OR 0.10; CrI 0.02, 0.35, p < 0.01), PEI (OR 0.06; CrI 0.01, 0.31, p < 0.01). Besides, RFA conferred the highest efficacy for survival, time to recurrence, and new development of HCC.
SR was superior to PEI. Although SR achieved highest cumulative ranking probabilities in clinical efficacy, it obtained a low benefit-to-risk ratio for patients. RFA was superior to the other ablative therapies. For tumor sizes > 2 cm or ≤ 2 cm in diameter, SR conferred non-significant effects compared with other therapies for SHCC.
小肝细胞癌 (SHCC) 的主要治疗方法包括经皮乙醇注射 (PEI)、经皮醋酸注射 (PAI)、射频消融 (RFA) 或手术切除 (SR)。我们旨在比较这些治疗方法的有效性和安全性。
我们对 Cochrane 图书馆、PubMed 和 Embase 进行了检索，检索时间截至 2017 年 4 月 30 日，以获取随机对照试验 (RCT)。使用比值比 (OR) 比较死亡率 (PD)、局部复发率 (LR) 和不良事件 (AE)。
共纳入 14 项 RCT。与 SR 相比，PEI 增加 PD 风险 (OR 2.79，CrI 1.25, 6.45，p < 0.01)。同样，PEI 导致 LR 增加 (OR 4.29，CrI 1.18, 18.35，p < 0.01)。此外，SR 比 RFA 更易出现 AE (OR 0.10；CrI 0.02, 0.35，p < 0.01)，也比 PEI 更易出现 AE (OR 0.06；CrI 0.01, 0.31，p < 0.01)。此外，RFA 在生存、复发时间和新 HCC 发展方面效果最好。
SR 优于 PEI。尽管 SR 在临床疗效方面的累积排名概率最高，但对患者的获益风险比却较低。RFA 优于其他消融治疗方法。对于肿瘤大小 >2cm 或直径 ≤2cm 的患者，SR 与其他治疗方法相比效果不显著。
