Eriguchi Takahisa, Takeda Atsuya, Tateishi Yudai, Tsurugai Yuichiro, Sanuki Naoko, Ebinuma Hirotoshi, Horita Nobuyuki
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita, Japan.
Hepatol Res. 2021 Jul;51(7):813-822. doi: 10.1111/hepr.13647. Epub 2021 May 5.
Stereotactic body radiotherapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC) and has shown excellent local control (LC), as has radiofrequency ablation (RFA). As no randomized controlled trial has compared SBRT and RFA for HCC, data from a propensity score matched study (PSMS) are valuable. However, the results varied greatly and depended on composing factors of Barcelona Clinic Liver Cancer staging (BCLC-factors) adjusted. Therefore, we undertook a systematic review and meta-analyses of the studies focusing on BCLC-factors matching.
We systematically searched PubMed, the Cochrane database, EMBASE, and Web of Science to identify studies comparing RFA and SBRT using propensity scores. The hazard ratios (HRs) of overall survival (OS) and LC from BCLC-factor-matched and -unmatched PSMS were pooled. Heterogeneity between the data from these studies was assessed.
Three BCLC-factor-matched studies were identified. Stereotactic body radiotherapy led to comparable OS (HR, 0.89; 95% CI, 0.74-1.08; p = 0.24; I = 0%; p for heterogeneity, 0.56) and significantly better LC (HR, 0.39; 95% CI, 0.30-0.51; p < 0.001; I = 0%; p for heterogeneity, 0.67). We also identified three additional BCLC-factor-unmatched studies (HR of OS, 1.41; 95% CI, 1.21-1.65; p < 0.0001; I = 0%; p for heterogeneity, 0.63). However, considerable heterogeneity was observed for HR of OS between BCLC-factor-matched and -unmatched studies (I = 92.6%; p for heterogeneity, 0.0002).
When BCLC-factors were properly adjusted, the results of the meta-analysis revealed equivalent OS and better LC for SBRT compared with RFA. Stereotactic body radiotherapy could be an alternative treatment option for HCC.
立体定向体部放疗（SBRT）是一种新兴的肝细胞癌（HCC）治疗方法，已显示出良好的局部控制（LC）效果，射频消融（RFA）亦是如此。由于尚无随机对照试验比较SBRT和RFA治疗HCC的疗效，倾向评分匹配研究（PSMS）的数据很有价值。然而，结果差异很大，且取决于调整后的巴塞罗那临床肝癌分期（BCLC）的构成因素。因此，我们对聚焦于BCLC因素匹配的研究进行了系统评价和荟萃分析。
我们系统检索了PubMed、Cochrane数据库、EMBASE和科学网，以识别使用倾向评分比较RFA和SBRT的研究。汇总了BCLC因素匹配和未匹配的PSMS中总生存（OS）和LC的风险比（HR）。评估了这些研究数据之间的异质性。
确定了3项BCLC因素匹配的研究。立体定向体部放疗导致相当的OS（HR，０.89；95%CI，0.74 - 1.08；p = 0 .24；I² = 0%；异质性p，0.56）和显著更好的LC（HR，0.39；95%CI，0.30 - 0.51；p < 0.001；I² = 0%；异质性p，0.67）。我们还确定了另外3项BCLC因素未匹配的研究（OS的HR，1.41；95%CI，1.21 - 1.65；p < 0.0001；I² = 0%；异质性p，0.63）。然而，在BCLC因素匹配和未匹配的研究之间，观察到OS的HR存在相当大的异质性（I² = 92.6%；异质性p，0.0002）。
当BCLC因素得到适当调整时，荟萃分析结果显示，与RFA相比，SBRT的OS相当，LC更好。立体定向体部放疗可能是HCC的一种替代治疗选择。
