钇- 90微球经动脉放疗栓塞治疗不可切除原发性肝癌疗效的Meta分析

doi:10.3877/cma.j.issn.2095-3232.2014.06.006

目的

评价钇-90微球经动脉放疗栓塞（TARE）治疗不可切除原发性肝癌（肝癌）的疗效。

方法

在Medline、Web of Science、Cochrane Controlled Trial Register (CENTRAL)和EMBASE数据库中检索2009年1月至2013年12月文献，英文检索词主要包括radioembolization、transarterial radioembolization、TARE、selective internal radiation therapy、SIRT、Yttrium-90、90Y、chemoembolization、transarterial chemoembolization、TACE及hepatocellular carcinoma、HCC、liver cancer、liver tumor、liver neoplasm。辅以手工检索查找相关文献。将纳入文献的数据合并后，根据不同治疗方法将患者分为TARE组和经导管动脉化疗栓塞（TACE）组，提取患者肿瘤治疗反应情况和1、2、3年生存率的数据。采用Q检验进行文献异质性检验，采用绘制漏斗图和线性回归模型检验发表偏倚。

结果

经过筛选纳入的5篇文献质量为中高水平，共计591例患者，TARE组292例，TACE组299例。采取固定效应模型进行Meta分析，TARE组患者对肿瘤治疗反应优于TACE组（RR=1.50，P<0.05）。TARE组患者2、3年生存率高于TACE组（RR=1.56，2.04；P<0.05）。

结论

与TACE相比，TARE能明显提高不可切除肝癌患者的肿瘤治疗反应率和远期生存率。

关键词: 癌，肝细胞, 钇放射性同位素, 放射疗法, 化学栓塞，治疗性, Meta分析

Objective

To assess the effect of transarterial radioembolization (TARE) using Yttrium-90 microsphere for unresectable primary liver cancer (PLC).

Methods

Literature from January 2009 to December 2013 were searched in the Medline, Web of Science, Cochrane Controlled Trial Register (CENTRAL) and EMBASE databases with the search terms mainly including: radioembolization, transarterial radioembolization, TARE, selective internal radiation therapy, SIRT, Yttrium-90, 90Y, chemoembolization, transarterial chemoembolization (TACE), hepatocellular carcinoma, HCC, liver cancer, liver tumor, liver neoplasm and with the assistance of manual searching. Data of the included literature were merged and the patients were divided into TARE group and TACE group according to the different treatments. The data of tumor therapeutic response and 1-, 2-, 3-year survival rates were collected. Literature heterogeneity inspection was conducted by Q test. Publication bias was tested by drawing funnel plot and linear regression model.

Results

Five articles were included after screening with the quality of medium to high. There were totally 591 cases with 292 in TARE group and 299 in TACE group. Meta-analysis was conducted using fixed effect model. Tumor therapeutic response was observed better in TARE group, compared with that in TACE group (RR=1.50, P<0.05). The 2-, 3-year survival rates in TARE group were significantly higher than those in TACE group (RR=1.56, 2.04; P<0.05).

Conclusions

Compared with TACE, TARE can obviously improve the tumor therapeutic response rate and long-term survival rate of patients with unresectable PLC.

Key words: Carcinoma, hepatocellular, Yttrium, radioisotopes, Radiotherapy, Chemoembolization, therapeutic, Meta-analysis

表1 TARE与TACE治疗不可切除肝癌Meta分析入选文献基本情况

研究作者	发表时间（年份）	治疗方法（例）		随访时间（月）		NOS评分（分）	质量
研究作者	发表时间（年份）	TARE	TACE	TARE	TACE	NOS评分（分）	质量
Lewandowski RJ,et al^[6]	2009	43	43	34^a	52^a	6	高
Kooby DA,et al^[7]	2010	27	44	6	6	5	中
Lance C,et al^[8]	2011	38	35	12	16	5	中
Salem R,et al^[9]	2011	123	122	23	33	7	高
Moreno-Luna LE，et al^[10]	2013	61	55	>52	>52	5	中

表1 TARE与TACE治疗不可切除肝癌Meta分析入选文献基本情况

研究作者	发表时间（年份）	治疗方法（例）		随访时间（月）		NOS评分（分）	质量
研究作者	发表时间（年份）	TARE	TACE	TARE	TACE	NOS评分（分）	质量
Lewandowski RJ,et al^[6]	2009	43	43	34^a	52^a	6	高
Kooby DA,et al^[7]	2010	27	44	6	6	5	中
Lance C,et al^[8]	2011	38	35	12	16	5	中
Salem R,et al^[9]	2011	123	122	23	33	7	高
Moreno-Luna LE，et al^[10]	2013	61	55	>52	>52	5	中

图1 TARE组与TACE组肝癌患者肿瘤治疗反应比较的Meta分析森林图

图2 TARE组与TACE组肝癌患者1年生存率比较的Meta分析森林图

图3 TARE组与TACE组肝癌患者2年生存率比较的Meta分析森林图

图4 TARE组与TACE组肝癌患者3年生存率比较的Meta分析森林图

[1]	Jemal A, Bray F, Center MM, et al. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2):69-90.
[2]	Meza-Junco J, Montano-Loza AJ, Liu DM, et al. Locoregional radiological treatment for hepatocellular carcinoma: which, when and how?[J]. Cancer Treat Rev, 2012, 38(1):54-62.
[3]	沈海洋，刘瑞宝．钇90微球经肝动脉选择性放射治疗肝肿瘤应用现状[J]．实用肿瘤学杂志，2009, 23(6):582-585.
[4]	Giammarile F, Bodei L, Chiesa C, et al. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds[J]. Eur J Nucl Med Mol Imaging, 2011, 38(7):1393-1406.
[5]	Riaz A, Kulik L, Lewandowski RJ, et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres[J]. Hepatology, 2009, 49(4):1185-1193.
[6]	Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization[J]. Am J Transplant, 2009, 9(8):1920-1928.
[7]	Kooby DA, Egnatashvili V, Srinivasan S, et al. Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma[J]. J Vasc Interv Radiol, 2010, 21(2):224-230.
[8]	Lance C, Mclennan G, Obuchowski N, et al. Comparative analysis of the safety and efficacy of transcatheter arterial chemoembolization and yttrium-90 radioembolization in patients with unresectable hepatocellular carcinoma[J]. J Vasc Interv Radiol, 2011, 22(12):1697-1705.
[9]	Salem R, Lewandowski RJ, Kulik L, et al. Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma[J]. Gastroenterology, 2011, 140(2):497-507.
[10]	Moreno-Luna LE, Yang JD, Sanchez W, et al. Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma[J]. Cardiovasc Intervent Radiol, 2013, 36(3):714-723.
[11]	吕毅，张谞丰．肝细胞肝癌的多学科协作组概念及其实践[J/CD]．中华肝脏外科手术学电子杂志，2013, 2(1):1-3.
[12]	Wigg AJ, Palumbo K, Wigg DR. Radiotherapy for hepatocellular carcinoma: systematic review of radiobiology and modeling projections indicate reconsideration of its use[J]. J Gastroenterol Hepatol, 2010, 25(4):664-671.
[13]	Sangro B, Salem R, Kennedy A, et al. Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations[J]. Am J Clin Oncol, 2011, 34(4):422-431.
[14]	Ray CJ Jr, Battaglia C, Libby AM, et al. Interventional radiologic treatment of hepatocellular carcinoma: a cost analysis from the payer perspective[J]. J Vasc Interv Radiol, 2012, 23(3):306-314.
[15]	李少华，陈敏山．经皮穿刺肝动脉化疗栓塞在肝细胞肝癌根治性切除术后的应用[J/CD]．中华肝脏外科手术学电子杂志，2013, 2(5):281-284.
[16]	Sangro B, Iñarrairaegui M, Bilbao JI. Radioembolization for hepatocellular carcinoma[J]. J Hepatol, 2012, 56(2):464-473.
[17]	刘允怡，赖俊雄，刘晓欣．钇90微球治疗原发性肝癌[J]．临床肝胆病杂志，2011, 27(4):348-350.

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Effect of Yttrium-90 microsphere transarterial radioembolization for unresectable primary liver cancer: a Meta-analysis

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Effect of Yttrium-90 microsphere transarterial radioembolization for unresectable primary liver cancer: a Meta-analysis