切换至 "中华医学电子期刊资源库"
高级检索
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 ›› 2017, Vol. 06 ›› Issue (04) : 280 -284. doi: 10.3877/cma.j.issn.2095-3232.2017.04.010

所属专题： 文献；

临床研究

射频消融与手术切除治疗早期肝细胞癌疗效比较Meta分析
崔瑞文1, 朱曙光1, 范磊2, 郑世杨3, 李华1,†()   
  1. 1. 510630　广州，中山大学附属第三医院肝脏外科
    2. 510630　广州，中山大学附属第三医院脊柱外科
    3. 510630　广州，中山大学附属第三医院甲乳外科
  • 收稿日期:2017-03-20 出版日期:2017-08-10
  • 通信作者: 李华
  • 基金资助:
    国家自然科学基金(81172038); 广东省自然科学基金(2014A020212484)

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

Ruiwen Cui1, Shuguang Zhu1, Lei Fan2, Shiyang Zheng3, Hua Li1,†()   

  1. 1. Department of Liver Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    3. Department of Breast and Thyroid Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2017-03-20 Published:2017-08-10
  • Corresponding author: Hua Li
  • About author:
    Corresponding author:Li Hua, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

崔瑞文, 朱曙光, 范磊, 郑世杨, 李华. 射频消融与手术切除治疗早期肝细胞癌疗效比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2017, 06(04): 280-284.

Ruiwen Cui, Shuguang Zhu, Lei Fan, Shiyang Zheng, Hua Li. Comparison of clinical efficacy between radiofrequency ablation and surgical resection for early hepatocellular carcinoma: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 280-284.

目的

比较射频消融（RFA）和手术切除（SR）治疗早期肝细胞癌（肝癌）的疗效。

方法

计算机检索2004年1月至2017年2月在PubMed、Embase、Web of science、中国知网和万方数据库公开发表的有关RFA和SR治疗早期肝癌的文献。英文检索词包括：hepatocellular carcinoma、liver cancer、hepatic carcinoma、liver neoplasms、HCC、radiofrequency ablation、ablative therapy、RFA、surgical resection、hepatectomy。中文检索词包括：肝细胞癌、肝癌、肝脏肿瘤、射频消融、手术切除。对符合米兰标准的早期肝癌患者提取生存率、并发症发生率及围手术期住院时间等数据进行Meta分析。异质性研究采用随机效应模型分析，同质性研究采用固定效应模型分析。

结果

共纳入20篇文献，其中4篇为随机对照试验研究，16篇为回顾性研究。共包括3 849例早期肝癌患者，其中1 946例行SR治疗，1 903例行RFA治疗。SR患者术后3、5年总体生存率较RFA患者明显升高（OR=1.09，1.58；P<0.05）。SR患者术后1、3、5年无瘤生存率较RFA患者明显升高（OR=1.88，2.31，2.14；P<0.05）。SR患者术后1、3、5年肿瘤复发率较RFA患者明显降低（OR=0.57，0.18，0.46；P<0.05）。SR患者术后并发症发生率较RFA患者明显升高（OR=3.84，P<0.05）。SR患者围手术期住院时间较RFA患者明显延长（WMD=7.08，P<0.05）。

结论

对于符合米兰标准的早期肝癌患者，SR长期生存及复发方面明显优于RFA，但RFA具有微创、并发症发生率低、住院时间短等优势。

关键词: 癌，肝细胞, 导管消融术, 肝切除术, 疗效比较研究
Objective

To compare the clinical efficacy between radiofrequency ablation (RFA) and surgical resection (SR) for early hepatocellular carcinoma (HCC).

Methods

Open published literatures related to RFA and SR for the treatment of early HCC between January 2004 and February 2017 were searched by computer from PubMed, Embase, Web of science, CNKI and Wanfang databases. The researching keywords in Chinese and English included hepatocellular carcinoma, liver cancer, hepatic carcinoma, liver neoplasms, HCC, radiofrequency ablation, ablative therapy, RFA, surgical resection and hepatectomy. The clinical data including survival rate, incidence of complication and perioperative length of hospital stay of the early HCC patients up to the standard of Milan criteria were extracted for Meta-analysis. Heterogenous studies were analyzed using random effect model, and homogenous studies were analyzed using fixed effect model.

Results

A total of 20 literatures including 4 randomized control trials and 16 retrospective studies were included in this Meta-analysis. In total, 3 849 patients with early HCC were analyzed. Among the patients, 1 946 cases underwent SR and 1 903 underwent RFA. The postoperative 3-, 5-year overall survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.09, 1.58; P<0.05). The postoperative 1-, 3-, 5-year tumor-free survival rate of the SR patients was significantly higher than those of the RFA patients (OR=1.88, 2.31, 2.14; P<0.05). The postoperative 1-, 3-, 5-year tumor recurrence rate of the SR patients was significantly lower than those of the RFA patients (OR=0.57, 0.18, 0.46; P<0.05). The incidence of postoperative complications of the SR patients was significantly higher than that of the RFA patients (OR=3.84, P<0.05). The perioperative length of hospital stay of the SR patients was significantly higher than that of the RFA patients (WMD=7.08, P<0.05).

Conclusions

For early HCC patients up to the standard of Milan criteria, the long-term survival and recurrence of SR are significantly superior to those of RFA. Nevertheless, RFA has the advantages of minimal invasion, low incidence of postoperative complications and short length of hospital stay.

Key words: Carcinoma, hepatocellular, Catheter ablation, Hepatectomy, Comparative effectiveness research
图1 手术切除与射频消融治疗早期肝癌5年总体生存率比较Meta分析森林图
图2 纳入研究的发表偏倚漏斗图
[1]
Sartorius K, Sartorius B, Aldous C, et al. Global and country underestimation of hepatocellular carcinoma (HCC) in 2012 and its implications[J]. Cancer Epidemiol, 2015, 39(3):284-290.
[2]
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis[J]. N Engl J Med, 1996, 334(11):693-699.
[3]
张洪新．肝细胞肝癌微创综合治疗的现状与展望[J/CD]．中华肝脏外科手术学电子杂志，2013，2(3):146-148.
[4]
Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma[J]. J Hepatol, 2012, 57(4):794-802.
[5]
Huang J, Yan L, Cheng Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria[J]. Ann Surg, 2010, 252(6):903-912.
[6]
Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma[J]. Ann Surg, 2006, 243(3):321-328.
[7]
吕明德，匡铭，梁力建，等．手术切除和经皮热消融治疗早期肝癌的随机对照临床研究[J]．中华医学杂志，2006，86(12):801-805.
[8]
Desiderio J, Trastulli S, Pasquale R, et al. Could radiofrequency ablation replace liver resection for small hepatocellular carcinoma in patients with compensated cirrhosis? a 5-year follow-up[J]. Langenbecks Arch Surg, 2013, 398(1):55-62.
[9]
Wong KM, Yeh ML, Chuang SC, et al. Survival comparison between surgical resection and percutaneous radiofrequency ablation for patients in Barcelona Clinic Liver Cancer early stage hepatocellular carcinoma[J]. Indian J Gastroenterol, 2013, 32(4):253-257.
[10]
Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study[J]. Radiology, 2012, 262(3):1022-1033.
[11]
Lai EC, Tang CN. Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the Milan criteria- a comparative study [J]. Int J Surg, 2013, 11(1):77-80.
[12]
Liu PH, Hsu CY, Hsia CY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2 cm in a propensity score model[J]. Ann Surg, 2016, 263(3):538-545.
[13]
Hong SN, Lee SY, Choi MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function[J]. J Clin Gastroenterol, 2005, 39(3):247-252.
[14]
Hung HH, Chiou YY, Hsia CY, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas[J]. Clin Gastroenterol Hepatol, 2011, 9(1):79-86.
[15]
Wang JH, Wang CC, Hung CH, et al. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma[J]. J Hepatol, 2012, 56(2):412-418.
[16]
Kang TW, Kim JM, Rhim H, et al. Small hepatocellular carcinoma: radiofrequency ablation versus nonanatomic resection-propensity score analyses of long-term outcomes[J]. Radiology, 2015, 275(3):908-919.
[17]
Hocquelet A, Balageas P, Laurent C, et al. Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: a study of 281 Western patients[J]. Int J Hyperthermia, 2015, 31(7):749-757.
[18]
Gory I, Fink M, Bell S, et al. Radiofrequency ablation versus resection for the treatment of early stage hepatocellular carcinoma: a multicenter Australian study[J]. Scand J Gastroenterol, 2015, 50(5):567-576.
[19]
Bu X, Ge Z, Ma J, et al. Long-term efficacy of radiofrequency ablation compared to surgical resection for the treatment of small hepatocellular carcinoma[J]. J BUON, 2015, 20(2):548-554.
[20]
Pompili M, Saviano A, de Matthaeis N, et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma ≤3 cm. results of a multicenter Italian survey[J]. J Hepatol, 2013, 59(1):89-97.
[21]
Park EK, Kim HJ, Kim CY, et al. A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma[J]. Ann Surg Treat Res, 2014, 87(2):72-80.
[22]
Guan TP, Fang CH, Yang J, et al. A comparison between three-dimensional visualization guided hepatectomy and ultrasonography guided radiofrequency ablation in the treatment of small hepatocellular carcinoma within the milan criteria[J]. Biomed Res Int, 2016:8931732.
[23]
Vivarelli M, Guglielmi A, Ruzzenente A, et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver[J]. Ann Surg, 2004, 240(1):102-107.
[24]
Wakai T, Shirai Y, Suda T, et al. Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma < or =4 cm[J]. World J Gastroenterol, 2006, 12(4):546-552.
[25]
何坤，胡泽民，余元龙，等．精准肝切除在原发性肝癌中的应用[J/CD]．中华肝脏外科手术学电子杂志，2016，5(2):81-85.
[1] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[2] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[3] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[4] 汤海琴, 郭秀枝, 朱晓素, 赵世娣. “隧道法”腹腔镜解剖性左半肝切除术的临床安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 674-677.
[5] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[6] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[7] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[8] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[9] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[10] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[11] 唐灿, 李向阳, 秦浩然, 李婧, 王天云, 柯阳, 朱红. 原发性肝脏神经内分泌肿瘤单中心12例诊治与疗效分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 674-680.
[12] 张维志, 刘连新. 基于生物信息学分析IPO7在肝癌中的表达及意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 694-701.
[13] 陈安, 冯娟, 杨振宇, 杜锡林, 柏强善, 阴继凯, 臧莉, 鲁建国. 基于生物信息学分析CCN4在肝细胞癌中表达及其临床意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 702-707.
[14] 叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
[15] 吴晨瑞, 廖锐, 贺强, 潘龙, 黄平, 曹洪祥, 赵益, 王永琛, 黄俊杰, 孙睿锐. MDT模式下肝动脉灌注化疗联合免疫靶向治疗肝细胞癌多处转移一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 713-716.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号