Li L-Q, Su T-S, Wu Q-Y, Lin Z-T, Liang S-X
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
Clin Oncol (R Coll Radiol). 2023 Oct;35(10):652-664. doi: 10.1016/j.clon.2023.07.002. Epub 2023 Jul 13.
Surgical resection, stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) have seldom been compared for small hepatocellular carcinoma (HCC). We explored the treatment outcomes of SBRT for small HCC by conducting a network meta-analysis (NMA). We compared the efficacy and safety of surgical resection, RFA and SBRT for liver-confined small HCC (three or fewer lesions with a diameter ≤5 cm). The study endpoint included the odds ratios of the 1-, 3- and 5-year progression/recurrence/disease-free survival (disease progression-free survival; DPFS) and overall survival rates, as well as severe complications. Forty-five studies included 21 468 patients. In the NMA with comparable data, SBRT had comparable 1-, 3- and 5-year DPFS but significantly worse pooled long-term overall survival (3- and 5-year overall survival) than surgical resection (odds ratio 1.39, 95% confidential interval 1.3-1.89; odds ratio 1.33, 95% confidence interval 1.06-1.69, respectively). SBRT was associated with significantly better pooled 1-year DPFS compared with RFA (odds ratio 0.39, 95% confidence interval 0.15-0.97), with the remaining outcomes being comparable. SBRT had significantly less incidence of severe complications compared with surgical resection (odds ratio 0.62, 95% confidence interval 0.42-0.88) and RFA (odds ratio 0.2, 95% confidence interval 0.03-0.94). In conclusion, for small HCCs (≤5 cm) with one to three nodules, SBRT may be favourable to reduce the risks of severe complications. In terms of DPFS, SBRT may be recommended as an alternative first-line therapy for RFA and surgical resection. The results regarding overall survival should be interpreted with caution, considering the potentially uneliminated bias. There is a clear need for well-designed randomised trials to conclusively identify real differences in efficacy between these treatments, especially SBRT and surgical resection.
对于小肝癌（HCC），很少有人对手术切除、立体定向体部放疗（SBRT）和射频消融（RFA）进行比较。我们通过进行网络荟萃分析（NMA）来探究SBRT治疗小肝癌的疗效。我们比较了手术切除、RFA和SBRT治疗局限于肝脏的小肝癌（直径≤5cm的病灶不超过3个）的疗效和安全性。研究终点包括1年、3年和5年进展/复发/无病生存率（无疾病进展生存率；DPFS）和总生存率的比值比，以及严重并发症。45项研究纳入了21468例患者。在具有可比数据的NMA中，SBRT的1年、3年和5年DPFS相当，但汇总的长期总生存率（3年和5年总生存率）显著低于手术切除（比值比分别为1.39，95%置信区间1.3 - 1.89；比值比1.33，95%置信区间1.06 - 1.69）。与RFA相比，SBRT的汇总1年DPFS显著更好（比值比0.39，95%置信区间0.15 - 0.97），其余结果相当。与手术切除（比值比0.62，95%置信区间0.42 - 0.88）和RFA（比值比0.2，95%置信区间0.03 - 0.94）相比，SBRT的严重并发症发生率显著更低。总之，对于有1至3个结节的小肝癌（≤5cm），SBRT可能有利于降低严重并发症的风险。就DPFS而言，SBRT可被推荐为RFA和手术切除的替代一线治疗方法。考虑到潜在的未消除偏差，应谨慎解读总生存结果。显然需要设计良好的随机试验来最终确定这些治疗方法之间，尤其是SBRT和手术切除之间疗效的真正差异。
