腹腔镜射频消融与经皮射频消融治疗肝细胞癌比较的系统评价和荟萃分析
A systematic review and meta-analysis of the comparison of laparoscopic radiofrequency ablation to percutaneous radiofrequency ablation for hepatocellular carcinoma.
作者信息
Wang Ya-Qiong, Tan Zhen-Kun, Peng Zha, Huang Hai
机构信息
Hepatobiliary Surgical Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Graduate Institute, Guangxi Medical University, Nanning, Guangxi, China.
出版信息
Front Oncol. 2025 Mar 11;15:1559343. doi: 10.3389/fonc.2025.1559343. eCollection 2025.
BACKGROUND
The comparative evaluation of laparoscopic and percutaneous techniques for liver radiofrequency ablation remains unexplored. This study aims to determine the most effective ablation technique and patient selection for hepatocellular carcinoma (HCC) by analyzing the efficacy and safety of laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA).
METHODS
Two investigators (Y-QW and PZ) independently performed a literature search in the Cochrane Library, PubMed, Web of Science and Embase databases. Study quality was assessed using the Newcastle-Ottawa Scale or Cochrane risk-of-bias tool. Meta-analysis was conducted with Review Manager 5.4, applying either fixed- or random-effects models depending on study heterogeneity. The chi-square test (χ²) and I² statistics were employed for heterogeneity analysis.
RESULTS
Eight publications involving 1059 patients were included. Among them, 456 underwent LRFA and 603 underwent PRFA. LRFA showed a significantly better 3-year RFS than PRFA (OR: 1.89, 95% CI: 1.27-2.83, p = 0.002), the incidence rate of local recurrence was significantly fewer in the LRFA group (OR: 0.40, 95% CI: 0.23-0.69, p = 0.0010), but the postoperative hospital stay time was slightly shorter in the PFRA group (MD = 1.30; 95% CI 0.26 to 2.35; p=0. 01). Patients in the LRFA group had no significant difference in total postoperative complications, ablation success rates, overall survival (OS) and 1,5-year disease-free survival (DFS).
CONCLUSION
Both LRFA and PRFA are effective treatments for HCC. LRFA shows better oncologic outcomes, including lower local recurrence and improved mid-term DFS. PRFA is simpler, less invasive and shorter hospital stays. The choice should be tailored to individual patient needs, considering tumor characteristics, comorbidities, and available expertise. Future research should focus on large-scale, prospective trials to validate these findings.
SYSTEMATIC REVIEW AND REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024601797.
背景
腹腔镜与经皮肝射频消融技术的对比评估尚未得到充分研究。本研究旨在通过分析腹腔镜射频消融（LRFA）与经皮射频消融（PRFA）治疗肝细胞癌（HCC）的疗效和安全性，确定最有效的消融技术及患者选择标准。
方法
两名研究者（Y-QW和PZ）独立在Cochrane图书馆、PubMed、科学网和Embase数据库中进行文献检索。使用纽卡斯尔-渥太华量表或Cochrane偏倚风险工具评估研究质量。采用Review Manager 5.4进行荟萃分析，根据研究异质性采用固定效应模型或随机效应模型。使用卡方检验（χ²）和I²统计量进行异质性分析。
结果
纳入8篇涉及1059例患者的文献。其中，456例行LRFA，603例行PRFA。LRFA的3年无复发生存率显著优于PRFA（OR：1.89，95%CI：1.27-2.83，p = 0.002），LRFA组局部复发发生率显著更低（OR：0.40，95%CI：0.23-0.69，p = 0.0010），但PRFA组术后住院时间稍短（MD = 1.30；95%CI 0.26至2.35；p = 0.01）。LRFA组患者术后总并发症、消融成功率、总生存期（OS）及1、5年无病生存期（DFS）无显著差异。
结论
LRFA和PRFA都是治疗HCC的有效方法。LRFA显示出更好的肿瘤学结局，包括更低的局部复发率和改善的中期DFS。PRFA更简单、侵入性更小且住院时间更短。应根据患者个体需求进行选择，考虑肿瘤特征、合并症和现有专业技术。未来研究应聚焦于大规模前瞻性试验以验证这些发现。
系统评价与注册
Zotero 插件