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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2014, Vol. 03 ›› Issue (06) : 354 -358. doi: 10.3877/cma.j.issn.2095-3232.2014.06.006

所属专题： 文献；

临床研究

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
李慕行1, 张谞丰1, 程继文1, 朱迎1, 王万里1, 董健1, 龙志达1, 吕毅1,†()   
  1. 1. 710061　西安交通大学医学院第一附属医院肝胆外科　西安交通大学先进外科技术与工程研究所
  • 收稿日期:2014-07-24 出版日期:2014-12-10
  • 通信作者: 吕毅
  • 基金资助:
    国家自然科学基金(81127005)

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

Muxing Li1, Xufeng Zhang1, Jiwen Cheng1, Ying Zhu1, Wanli Wang1, Jian Dong1, Zhida Long1, Yi Lyu1,†()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2014-07-24 Published:2014-12-10
  • Corresponding author: Yi Lyu
  • About author:
    Corresponding author: Lyu Yi, Email:
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李慕行, 张谞丰, 程继文, 朱迎, 王万里, 董健, 龙志达, 吕毅. 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[J]. 中华肝脏外科手术学电子杂志, 2014, 03(06): 354-358.

Muxing Li, Xufeng Zhang, Jiwen Cheng, Ying Zhu, Wanli Wang, Jian Dong, Zhida Long, Yi Lyu. Effect of Yttrium-90 microsphere transarterial radioembolization for unresectable primary liver cancer: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2014, 03(06): 354-358.

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
TARE TACE TARE TACE
Lewandowski RJ,et al[6] 2009 43 43 34a 52a 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
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