微波消融与肝切除术治疗肝细胞癌和肝转移瘤的疗效比较：系统评价和荟萃分析。
The efficacy of microwave ablation versus liver resection in the treatment of hepatocellular carcinoma and liver metastases: A systematic review and meta-analysis.
机构信息
Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China.
Department of Hepatocellular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637007, China; Institute of Hepato-biliary-intestinal Disease, North Sichuan Medical College, Nanchong, 637000, China.
出版信息
Int J Surg. 2020 May;77:85-93. doi: 10.1016/j.ijsu.2020.03.006. Epub 2020 Mar 12.
BACKGROUND
Microwave ablation (MWA) is an important method in the treatment of liver cancer. This systematic review compared MWA with liver resection (LR) for liver cancer treatment. In recent years, the MWA has been also reported to play an important role. Studies comparing MWA and LR are lacking. This study aims to compare the efficacy of MWA and LR in the treatment of hepatocellular carcinoma (HCC).
METHODS
A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to April 1, 2019 was conducted for relevant studies that compared the efficacy of MWA and LR in the treatment of HCC. The primary outcomes were local tumor recurrence (LTR) and overall survival (OS) of patients. The secondary outcomes included disease free survival (DFS), extrahepatic metastasis, intrahepatic de novo lesions, length of stay, complications, intraoperative blood loss and operative time.
RESULTS
A total of 16 studies including 2622 patients were identified. Incidence of LTR was significantly higher in patients with MWA than LR, with a pooled OR of 2.69 (95% CI 1.33-5.41; P = 0.006). No significant difference in 1-year OS was found. However, patients with MWA experienced higher 3- and 5-year OS, with pooled ORs of 1.40 (95% CI 1.07-1.84; P = 0.01) and 1.41 (95% CI 1.10-1.80; P = 0.007) respectively. In secondary measures, the 1- and 3-year DFS were significantly higher in patients with MWA. However, no significant difference of 5-year DFS was observed. In addition, lower incidence of complications, less intraoperative blood loss and shorter operative time and shorter length of stay were observed in MWA.
CONCLUSIONS
Though MWA may lead to higher incidence of recurrence, it may be an effective and safe alternative in patients with HCC or liver metastases. MWA may have benefits in patients' survival and safety. Randomized studies should be performed to determine the target population that benefits most from MWA in the future.
背景
微波消融（MWA）是肝癌治疗的重要方法。本系统评价比较了 MWA 与肝切除术（LR）治疗肝癌的效果。近年来，MWA 的作用也得到了报道。目前缺乏 MWA 与 LR 比较的研究。本研究旨在比较 MWA 和 LR 治疗肝细胞癌（HCC）的疗效。
方法
系统检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，检索时限均为 2019 年 4 月 1 日之前，以获取比较 MWA 和 LR 治疗 HCC 疗效的相关研究。主要结局指标为患者的局部肿瘤复发（LTR）和总生存（OS）。次要结局指标包括无病生存（DFS）、肝外转移、肝内新发病变、住院时间、并发症、术中出血量和手术时间。
结果
共纳入 16 项研究，共计 2622 例患者。MWA 组患者的 LTR 发生率明显高于 LR 组，汇总 OR 为 2.69（95%CI 1.33-5.41；P=0.006）。两组患者 1 年 OS 率无显著差异。然而，MWA 组患者的 3 年和 5 年 OS 率更高，汇总 OR 分别为 1.40（95%CI 1.07-1.84；P=0.01）和 1.41（95%CI 1.10-1.80；P=0.007）。在次要指标中，MWA 组患者的 1 年和 3 年 DFS 显著更高。然而，5 年 DFS 率无显著差异。此外，MWA 组患者的并发症发生率较低，术中出血量更少，手术时间和住院时间更短。
结论
虽然 MWA 可能会导致更高的复发率，但对于 HCC 或肝转移患者来说，它可能是一种有效且安全的替代方法。MWA 可能对患者的生存和安全性有益。未来应开展随机研究，以确定从 MWA 中获益最大的目标人群。
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