CAJ | 학술논문

目的比较经皮射频消融(RFA)、无水乙醇注射(PEI)与手术切除(SR)治疗小肝癌(SHCC)的临床疗效.方法检索Cochrane Library、EMBASE、PubMed、CBM、CNKI、万方数据库和维普数据库,收集比较RFA或PEI与SR治疗SHCC效果的临床研究,应用Stata 12.0软件进行Meta分析.结果共纳入18篇研究.其中14篇为RFA与SR治疗研究,共1 959例患者;4篇为PEI与SR治疗研究,共12 038例患者.结果显示:术后1年生存率SR与RFA和PEI比较差异无统计学意义(P＞0.05).术后3年生存率SR优于RFA(RR3年=0.87,95％ CI:0.78 ～0.98,P＜0.05),而SR与PEI差异无统计学意义.术后5年生存率SR优于RFA(RR5年=0.71,95％ CI:0.51～0.98,P＜0.05)和PEI(RR5年=0.72,95％ CI:0.62～0.85,P＜0.05).术后1年无瘤生存时间SR与PFA和PEI差异均无统计学意义.术后3年无瘤生存时间SR优于PEI(RR3年=0.66,95％ CI:0.44 ～0.97,P＜0.05),而SR与RFA差异无统计学意义.术后5年无瘤生存时间SR优于RFA(RR5年=0.63,95％ CI:0.49～0.80,P＜0.05)和PEI(RR5年=0.67,95％ CI:0.44 ～0.98,P＜0.05).结论 SR治疗SHCC的远期总体疗效明显优于RFA和PEI,而近期疗效三种方法差异不明显.SR应该成为治疗SHCC的首选方法.
목적 비교경피사빈소융(RFA)、무수을순주사(PEI)여수술절제(SR)치료소간암(SHCC)적림상료효.방법 검색Cochrane Library、EMBASE、PubMed、CBM、CNKI、만방수거고화유보수거고,수집비교RFA혹PEI여SR치료SHCC효과적림상연구,응용Stata 12.0연건진행Meta분석.결과 공납입18편연구.기중14편위RFA여SR치료연구,공1 959례환자;4편위PEI여SR치료연구,공12 038례환자.결과현시:술후1년생존솔SR여RFA화PEI비교차이무통계학의의(P＞0.05).술후3년생존솔SR우우RFA(RR3년=0.87,95％ CI:0.78 ～0.98,P＜0.05),이SR여PEI차이무통계학의의.술후5년생존솔SR우우RFA(RR5년=0.71,95％ CI:0.51～0.98,P＜0.05)화PEI(RR5년=0.72,95％ CI:0.62～0.85,P＜0.05).술후1년무류생존시간SR여PFA화PEI차이균무통계학의의.술후3년무류생존시간SR우우PEI(RR3년=0.66,95％ CI:0.44 ～0.97,P＜0.05),이SR여RFA차이무통계학의의.술후5년무류생존시간SR우우RFA(RR5년=0.63,95％ CI:0.49～0.80,P＜0.05)화PEI(RR5년=0.67,95％ CI:0.44 ～0.98,P＜0.05).결론 SR치료SHCC적원기총체료효명현우우RFA화PEI,이근기료효삼충방법차이불명현.SR응해성위치료SHCC적수선방법.
Objective To study the therapeutic effects of percutaneous radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) or surgical resection (SR) for small hepatocellular carcinoma (SHCC).Methods The clinical data were collected from the databases of the Cochrane Collaboration, EMBASE, PubMed, CBM, China National Knowledge Infrastructure (CNKI), Wanfang and VIP database.A Meta-analysis was conducted using Stata 12.0 software.Results 18 RCTs (randomized controlled trials) were included into this study.Of the 14 studies which compared RFA with SR for 1 959 patients with SHCC, 1 016 patients received RFA and 943 patients received SR, respectively.Of the 4 studies which compared PEI with SR (n =12 038), 3 652 patients received PEI while 8 386 patients received SR.There were no significant differences in the post treatment 1-year overall survival rates (OS) among the SR, PEI and RFA groups.The 3-year OS was better in the SR group than the RFA group (RR 3 years =0.87,95％ CI: 0.78-0.98, Z =2.40,P ＜ 0.05), while there was no significant difference between the RFA and PEI groups.The 5 year OS was significantly better in the SR group than the RFA group (RR 5 ye~ =0.71,95％ CI:0.51-0.98 ,P ＜ 0.05) and the PEI group (RR 5 years =0.72,95％ CI:0.62-0.85, P ＜ 0.05).There were no significant differences in the 1-year tumor-free survival rates among the SR, RFA and PEI groups.The SR group was significantly better than the PEI group in the 3-year tumor-free survival rate (RR 3 years =0.66, 95％ CI:0.44-0.97 ,P ＜ 0.05), while there was no significant difference between the SR and RFA groups.The 5-year tumor-free survival rate in the SR group was significantly better than the RFA group (RR 5 years =0.63,95 ％ CI:0.49-0.80, Z =3.81, P ＜ 0.001) and the PEI group (RR 5 years =0.67,95 ％ CI:0.44-0.98, P ＜ 0.05).Conclusions The overall therapeutic effect of SR was better than RFA or PEI, in particular in the post-treatment overall survival rates and tumor-free survival rates.SR should be considered as the first choice of treatment for SHCC.