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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 ›› 2023, Vol. 12 ›› Issue (02) : 190 -195. doi: 10.3877/cma.j.issn.2095-3232.2023.02.013

所属专题： 临床研究；

临床研究

经动脉放疗栓塞术治疗不可切除肝内胆管细胞癌疗效与安全性Meta分析
吴添庆1, 王炯亮1, 郑梽楷1, 李文轩1, 周仲国1,†()   
  1. 1. 510060　广州，中山大学肿瘤防治中心肝脏外科　华南肿瘤学国家重点实验室　肿瘤医学协同创新中心
  • 收稿日期:2022-12-05 出版日期:2023-03-28
  • 通信作者: 周仲国
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(320.6705.2021-02-76); 中山大学肿瘤防治中心临床医学科学家基金(16zxqk04)

Efficacy and safety of transarterial radioembolization for unresectable intrahepatic cholangiocarcinoma: a Meta-analysis

Tianqing Wu1, Jiongliang Wang1, Zhikai Zheng1, Wenxuan Li1, Zhongguo Zhou1,†()   

  1. 1. Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
  • Received:2022-12-05 Published:2023-03-28
  • Corresponding author: Zhongguo Zhou
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吴添庆, 王炯亮, 郑梽楷, 李文轩, 周仲国. 经动脉放疗栓塞术治疗不可切除肝内胆管细胞癌疗效与安全性Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 190-195.

Tianqing Wu, Jiongliang Wang, Zhikai Zheng, Wenxuan Li, Zhongguo Zhou. Efficacy and safety of transarterial radioembolization for unresectable intrahepatic cholangiocarcinoma: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 190-195.

目的

探讨经动脉放疗栓塞术（TARE）治疗不可切除肝内胆管细胞癌（ICC）的疗效与安全性。

方法

检索PubMed、Embase、Cochrane Library数据库中TARE治疗不可切除ICC的所有英文文献。采用主题词联合自由词进行文献检索，检索词为cholangiocarcinoma、cholangiocellular carcinoma、unresectable、advanced、TARE、transarterial radioembolization等。检索时间从建库至2022年4月1日。主要指标为客观缓解率（ORR）；次要指标为1、2、3年生存率，不良反应发生率。采用Stata 12.0对文献进行Meta分析。

结果

共纳入18篇文献739例患者进行Meta分析。Meta分析显示，TARE治疗不可切除ICC的ORR为20.5%。其中钇90树脂微球组ORR为22.9%，钇90玻璃微球组为20.5%，差异无统计学意义（χ2=0.10，P=0.75）。体力状况较好组ORR为22.3%，体力状况较差组为12.4%，差异亦无统计学意义（χ2=2.05，P=0.15）。TARE治疗患者1、2、3年生存率分别为39.8%、17.9%、5.5%。TARE治疗后最常见的不良反应为乏力，发生率39%；严重不良反应主要为肝衰竭和消化性溃疡，发生率3.2%和2.9%。

结论

在不可切除ICC患者中，TARE的疗效尚可，严重不良反应发生率低。

关键词: 经动脉放疗栓塞术, 肝内胆管细胞癌, Meta分析
Objective

To evaluate the efficacy and safety of transarterial radioembolization (TARE) in the treatment of unresectable intrahepatic cholangiocarcinoma (ICC).

Methods

All literature in English related to TARE in the treatment of unresectable ICC were searched from PubMed, Embase and Cochrane Library databases. Literature search was carried out using subject words and free words, and the searching words were cholangiocarcinoma, cholangiocellular carcinoma, unresectable, advanced, TARE and transarterial radioembolization, etc. The retrieval time was from the database inception date to April 1, 2022. The main index was objective remission rate (ORR) and the secondary indexes were the 1-, 2- and 3-year survival rate and incidence of adverse reactions. Meta-analysis was performed by Stata 12.0 software.

Results

A total of 739 patients from 18 studies were included for Meta-analysis. Meta-analysis revealed that the ORR of TARE for unresectable ICC was 20.5%. The ORR in the Yttrium-90 resin microsphere group was 22.9%, and was 20.5% in the Yttrium-90 glass microsphere group, where no significant difference was observed (χ2=0.10, P=0.75). In the good physical condition group, the ORR was calculated as 22.3% and 12.4% in the poor physical condition group, and no significant difference was observed (χ2=2.05, P=0.15). The 1-, 2- and 3-year survival rates of patients treated with TARE were 39.8%, 17.9% and 5.5%, respectively. Fatigue was the most common adverse reaction after TARE with an incidence of 39%. The major severe adverse reactions consisted of liver failure (3.2%) and peptic ulcer (2.9%).

Conclusions

TARE yields acceptable clinical efficacy and low incidence of severe adverse reactions in patients with unresectable ICC.

Key words: Transarterial radioembolization, Intrahepatic cholangiocarcinoma, Meta-analysis
表1 纳入文献TARE治疗不可切除ICC患者的基本特征
纳入研究 年份 研究类型 治疗方案 样本量（例） 性别（例，男/女） 中位年龄（岁） ECOG-PS评分（例，0~1分/2分） NOS评分（分）
Ibrahim等[7] 2008 前瞻性 钇90玻璃微球 24 16/8 68 22/2 8
Saxena等[8] 2010 前瞻性 钇90树脂微球 25 13/12 57 22/3 8
Hoffmann等[4] 2012 回顾性 钇90树脂微球 33 18/15 65.2 24/9 6
Mouli等[9] 2013 前瞻性 钇90玻璃微球 46 25/21 68 45/1 8
Rafi等[10] 2013 回顾性 钇90树脂微球 19 7/12 63.3 15/4 8
Mosconi等[11] 2016 回顾性 钇90树脂微球 23 14/9 65 23/0 6
Akinwande等[12] 2017 回顾性 钇90玻璃微球，钇90树脂微球 25 8/17 64 - 7
Jia等[13] 2017 回顾性 钇90树脂微球 24 8/16 61.8 24/0 7
Swinburne等[14] 2017 回顾性 钇90树脂微球，钇90玻璃微球 29 14/15 66 24/5 6
Gangi等[15] 2018 回顾性 钇90玻璃微球 85 41/44 73.4 57/28 7
Reimer等[16] 2018 回顾性 钇90树脂微球 21 12/9 69.5 3/18 7
Koehler等[17] 2019 回顾性 钇90树脂微球 25 - 58 - 5
Köhler等[18] 2019 回顾性 钇90树脂微球 46 19/27 62.5 - 6
Buettner等[19] 2020 回顾性 钇90树脂微球 92 45/47 - 86/6 7
钇90玻璃微球 22 10/12 - 20/1
Bargellini等[20] 2020 回顾性 钇90树脂微球 81 49/2 62.4 81/0 7
Paprottka等[21] 2021 回顾性 钇90树脂微球 73 40/33 64.5 - 7
Sarwar等[22] 2021 回顾性 钇90树脂微球 31 20/11 69 31/0 7
Depalo等[23] 2021 回顾性 钇90树脂微球 15 10/5 61 14/0 6
图1 TARE治疗不可切除ICC患者ORR的森林图注：TARE为经动脉放疗栓塞术，ICC为肝内胆管细胞癌，ORR为客观缓解率，ES为效应值，Weight为权重
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