中国实用外科杂志

中国实用外科杂志

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手术切除与射频消融治疗早期肝癌疗效Meta分析

张玉盼1，侯建存2，淮明生2，李    阳2，崔子林2，张雅敏2   

  1. 1天津医科大学一中心临床学院，天津 300070；2天津市第一中心医院肝胆外科，天津 300192
  • 出版日期:2015-11-01 发布日期:2015-10-29

  • Online:2015-11-01 Published:2015-10-29

摘要：

目的    比较早期肝细胞癌（HCC）病人行手术切除（SR）和射频消融（RFA）的术后存活率和无瘤存活率。方法    检索2004年1月至 2014年10月PubMed、MEDLINE、EMBASE、Cochrane图书馆数据库以及万方、CNKI数据库中收录的关于早期HCC行SR与RFA疗效比较的文献，根据纳入及排除标准选择文献，采用Stata11进行Meta分析，利用固定效应模型或随机效应模型计算术后1年、2年、3年、5年总体存活率及1年、2年、3年无瘤存活率的比值比（OR）及其95%可信区间（95%CI），应用漏斗图及Egger检验评估文献的发表偏倚。结果    共纳入5篇随机对照研究和8篇回顾性研究。共统计12 580例早期HCC病人，其中SR组6237例，RFA组6343例。SR组和RFA组在1年总存活率上差异无统计学意义（P＞0.05），SR组2、3、5年总存活率明显高于RFA组，差异有统计学意义（P＜0.05）；SR组1、2、3年无瘤存活率明显高于RFA组，差异有统计学意义（P＜0.05）。结论    SR治疗早期HCC病人的术后总存活率和无瘤存活率均高于RFA治疗。

关键词: 肝细胞癌, 射频消融, 米兰标准, 手术切除, Meta分析

Abstract:

Surgical resection versus radiofrequency ablation for early hepatocellular carcinoma：A meta-analysis                        ZHANG Yu-pan*，HOU Jian-cun，HUAI Ming-sheng，et al. *The First Center Clinical College of Tianjin Medical University，Tianjin 300070，China
Corresponding author：HUAI Ming-sheng，E-mail：hmsh-7332@163.com
Abstract    Objective    To compare the postoperative survival rate and disease-free survival rate of radiofrequency ablation （RFA） versus surgical resection（SR）for patients with early hepatocellular carcinoma (HCC) within the Milan Criteria. Methods    Randomized controlled trials (RCT) or retrospective studies (RS) comparing the RFA with SR for patients with early HCC within the Milan Criteria published from January 2004 to October 2014 were selected from database of PubMed, MEDLINE,  EMBASE, Cochrane library, Wanfang and CNKI. Identify the txts according to the predefined inclusion and exclusion criteria．Statistical data analysis was performed with the Stata 11 software. The outcomes included1,2,3,5 year overall survival rate and 1,2,3 year recurrence-free survival rate. Individual and pooled odds ratios with 95% confidence-interval of each outcome were analyzed. Funnel plot and Egger test were applied to assess the publication bias of the literatures. Results    Five RCTs and eight RSs were included with a total of 12 580 early stage patients (SR 6237, RFA 6343). The 2-,3-and 5-year but rather than 1-year overall survival rates of SR were significantly higher than those of RFA（P＜0.05）. The 1-,2- and 3-year recurrence-free survival rate of SR were significantly higher than those of RFA（P＜0.05）. Conclusion    SR led to a higher overall survival and recurrence-free survival rate than RFA in treating early HCC.

Key words: hepatocellular carcinoma, radiofrequency ablation, Milan Criteria, surgical resection, meta-analysis