复发性肝细胞癌再次手术切除与射频消融临床疗效比较的Meta分析

doi:10.3877/cma.j.issn.2095-3232.2017.01.008

目的

探讨再次手术切除（SRR）与射频消融（RFA）治疗复发性肝细胞癌（肝癌）的临床疗效差别。

方法

计算机检索2010年1月至2016年1月Medline、PubMed、Cochrane、CNKI、CBM、万方、维普等数据库。英文检索词：hepatocellular carcinoma、hepatic carcinoma、liver cancer、liver neoplasms、HCC、recurrent、recurrence、relapse、recurring、resection、hepatectomy、radio frequency ablation、ablation、radio frequency、radio-frequency、RFA、PRFA。中文检索词：肝癌、肝细胞癌、肝肿瘤、复发、手术、射频消融。将患者分为SRR组和RFA组，对两组术后3年生存率、3年无瘤生存率、3年复发率、并发症发生率、住院时间等结局指标进行Meta分析。

结果

共有8篇文献，856例患者纳入本研究。其中随机对照实验1篇，回顾性分析文献7篇。Meta分析结果显示，两组3年生存率差异无统计学意义（OR=1.02，95%CI：0.75～1.39；P>0.05）。SSR组3年无瘤生存率优于RFA组（OR=1.63，95%CI：1.05～2.54；P<0.05）。两组3年复发率差异无统计学意义（OR=0.85，95%CI：0.48～1.49；P>0.05）。SRR组术后Clavien Ⅱ级以上并发症发生率明显高于RFA组（OR=13.33，95%CI：2.43～73.06；P<0.05）。SRR组住院时间明显长于RFA组（SMD=5.23，95%CI：2.85～7.61；P<0.05）。

结论

对于复发性肝癌的治疗，两种治疗方法的总体生存率无明显差异，但SRR治疗的无瘤生存率优于RFA。RFA具有临床安全性相对较高、住院时间较短等优势。

关键词: 癌，肝细胞, 再手术, 导管消融术, Meta分析

Objective

To compare the difference of clinical efficacy between surgical re-resection (SRR) and radiofrequency ablation (RFA) for recurrent hepatocellular carcinoma (HCC).

Methods

Literature from the databases Medline, PubMed, Cochrane, CNKI, CBM, Wangfang and VIP between January 2010 and January 2016 was searched. The English keywords were hepatocellular carcinoma, hepatic carcinoma, liver cancer, liver neoplasms, HCC, recurrent, recurrence, relapse, recurring, resection, hepatectomy, radio frequency ablation, ablation, radio frequency, radio-frequency, RFA and PRFA. And the Chinese keywords were liver cancer, hepatocellular carcinoma, liver neoplasms, recurrence, surgery and RFA. The patients were divided into the SRR group and RFA group. The outcome indicators including the 3-year survival rate, 3-year tumor-free survival rate, 3-year recurrence rate, incidence of complications and length of hospital stay after surgery of two groups were analyzed using Meta-analysis.

Results

A total of 8 literatures, 856 patients were included in this study, including 1 randomized controlled trial and 7 retrospective studies. The Meta-analysis results revealed that no significant difference was observed in the 3-year survival rate between two groups (OR=1.02, 95%CI: 0.75-1.39, P>0.05). The 3-year tumor-free survival rate in the SSR group was significantly higher than that in the RFA group (OR=1.63, 95%CI: 1.05-2.54, P<0.05). No significant difference was observed in the 3-year recurrence rate between two groups (OR=0.85, 95%CI: 0.48-1.49, P>0.05). The incidence of complications above Clavien grade Ⅱ after surgery in the SRR group was significantly higher than that in the RFA group (OR=13.33, 95%CI: 2.43-73.06, P<0.05). The length of hospital stay in the SRR group was significantly longer than that in the RFA group (SMD=5.23, 95%CI: 2.85-7.61, P<0.05).

Conclusions

For the treatment of recurrent HCC, there is no significant difference in the overall survival rate between SRR and RFA, but the tumor-free survival rate in the SRR group is significantly higher than that in the RFA group, whereas RFA has the advantages of higher safety and shorter length of hospital stay.

Key words: Carcinoma, hepatocellular, Reoperation, Catheter ablation, Meta-analysis

表1 复发性肝细胞癌再次手术切除与射频消融疗效Meta分析入选文献基本信息

作者	年份	例数	平均年龄（岁）	性别比（男∶女）		肿瘤直径（cm）
作者	年份	例数	平均年龄（岁）	SRR	RFA	SRR	RFA
罗嘉等^[8]	2011	47	-	21∶3	021∶2	-	-
董晓刚等^[9]	2011	63	52	16∶2	012∶5	-	-
梁惠宏等^[10]	2011	151	63	65∶7	069∶10	2.16±0.10	2.46±0.10
张辉等^[11]	2013	168	-	-	-	3.50	2.10
黄新辉等^[12]	2013	112	52	51∶15	036∶10	2.90±1.10	2.60±0.90
吴斌等^[13]	2014	60	60±6	38∶22	-	4.30±0.82	-
张婷婷等^[14]	2014	66	50±13	25∶2	037∶2	3.20±1.00	2.70±1.10
Song等^[15]	2015	217	55	31∶8	145∶33	2.20±1.10	1.70±0.60

表1 复发性肝细胞癌再次手术切除与射频消融疗效Meta分析入选文献基本信息

作者	年份	例数	平均年龄（岁）	性别比（男∶女）		肿瘤直径（cm）
作者	年份	例数	平均年龄（岁）	SRR	RFA	SRR	RFA
罗嘉等^[8]	2011	47	-	21∶3	021∶2	-	-
董晓刚等^[9]	2011	63	52	16∶2	012∶5	-	-
梁惠宏等^[10]	2011	151	63	65∶7	069∶10	2.16±0.10	2.46±0.10
张辉等^[11]	2013	168	-	-	-	3.50	2.10
黄新辉等^[12]	2013	112	52	51∶15	036∶10	2.90±1.10	2.60±0.90
吴斌等^[13]	2014	60	60±6	38∶22	-	4.30±0.82	-
张婷婷等^[14]	2014	66	50±13	25∶2	037∶2	3.20±1.00	2.70±1.10
Song等^[15]	2015	217	55	31∶8	145∶33	2.20±1.10	1.70±0.60

图1 SRR组与RFA组复发性肝细胞癌患者3年生存率的Meta分析森林图

图2 SRR组与RFA组复发性肝细胞癌患者3年无瘤生存率的Meta分析森林图

图3 SRR组与RFA组复发性肝细胞癌患者3年复发率的Meta分析森林图

图4 SRR组与RFA组复发性肝细胞癌患者Clavien Ⅱ级以上并发症发生率的Meta分析森林图

图5 SRR组与RFA组复发性肝细胞癌患者住院时间的Meta分析森林图

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Comparison of clinical efficacy between surgical re-resection and radiofrequency ablation for recurrent hepatocellular carcinoma: a Meta-analysis

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Comparison of clinical efficacy between surgical re-resection and radiofrequency ablation for recurrent hepatocellular carcinoma: a Meta-analysis