射频消融术与腹腔镜肝切除术治疗肝细胞癌的系统评价和荟萃分析

Radiofrequency ablation versus laparoscopic hepatectomy for treatment of hepatocellular carcinoma: a systematic review and meta-analysis.

作者信息

Jin Shan, Tan Shisheng, Peng Wen, Jiang Ying, Luo Chunshan

机构信息

Department of oncology, People's Hospital of Guizhou province, Guiyang City, China.

Department of orthopedic, Guizhou Orthopedic Hospital, No. 184, Zhongshan East Road, Nanming District, Guiyang City, 550000, Guizhou Province, China.

出版信息

World J Surg Oncol. 2020 Aug 12;18(1):199. doi: 10.1186/s12957-020-01966-w.

BACKGROUND

Several randomized controlled trials (RCTs) compared the effects of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), but the results have remained inconsistent. Hence, a meta-analysis and a systematic review of these treatment modalities are necessary to evaluate their efficacy and safety for HCC treatment.

METHODS

From the inception of this meta-analysis and review until August 31, 2019, we searched Medline, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database for RCTs involving LH and RFA treatments of patients with HCC. The studies were screened and the data from these articles were extracted independently by two authors. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome with a fixed- or random-effect model. The outcomes for effectiveness evaluations included duration of surgery, estimated bleeding volume, incidence of blood transfusion during surgery, duration of hospital stay, and the outcome for safety included the incidence of cancer recurrence.

RESULTS

Seven RCTs with a total of 615 patients were identified, 312 and 303 of which underwent RFA and LH treatments, respectively. The duration of surgery (MD = -99.04; 95% CI: -131.26--66.82), estimated bleeding volume (MD = -241.97; 95% CI: -386.93--97.02), incidence of blood transfusion during surgery (OR = 0.08; 95% CI: 0.02-0.37), and duration of hospital stay (MD = -3.4; 95% CI: -5.22--1.57) in RFA treatment were significantly lower than those of LH treatment. However, the incidence of cancer recurrence was significantly higher for RFA treatment compared with LH treatment (OR = 2.68; 95% CI: 1.72-4.18).

CONCLUSIONS

LH treatment is preferred over RFA treatment with a better radical effect, but RFA treatment is more beneficial with smaller trauma, development of less complications, and shorter operating time when compared with HCC treatment.

背景

多项随机对照试验（RCT）比较了腹腔镜肝切除术（LH）和射频消融术（RFA）治疗肝细胞癌（HCC）的效果，但结果仍不一致。因此，有必要对这些治疗方式进行荟萃分析和系统评价，以评估它们治疗HCC的疗效和安全性。

方法

从本荟萃分析和综述开始至2019年8月31日，我们检索了Medline、PubMed、EMBASE、Cochrane图书馆、中国知网、万方数据库和中国生物医学文献数据库，以查找涉及LH和RFA治疗HCC患者的RCT。由两名作者独立筛选研究并提取这些文章的数据。采用固定效应模型或随机效应模型为每个结局计算汇总比值比（OR）或均值差（MD）及其95%置信区间（CI）。有效性评估的结局包括手术时长、估计出血量、术中输血发生率、住院时长，安全性结局包括癌症复发率。

结果

共纳入7项RCT，总计615例患者，其中分别有312例和303例接受了RFA和LH治疗。RFA治疗的手术时长（MD = -99.04；95% CI：-131.26至-66.82）、估计出血量（MD = -241.97；95% CI：-386.93至-97.02）、术中输血发生率（OR = 0.08；95% CI：0.02 - 0.37）和住院时长（MD = -3.4；95% CI：-5.22至-1.57）均显著低于LH治疗。然而，与LH治疗相比，RFA治疗的癌症复发率显著更高（OR = 2.68；95% CI：1.72 - 4.18）。