术前经导管动脉内化疗栓塞术对可切除性肝细胞癌围术期安全性影响的Meta分析

Effect of preoperative transarterial chemoembolization on perioperative safety of patients with resectable hepatocellular carcinoma: a Meta-analysis

    摘要
  • 摘要: 目的:系统评价术前TACE对可切除性肝细胞癌围术期安全性的影响。
    方法:以肝细胞癌、肝切除、术前化疗栓塞、经动脉化疗栓塞、liver cancer、hepatocellular carcinoma、liver resection、hepatectomy、transcatheter arterial chemoembolization、transarterial chemoembolization、preoperative等为检索词，检索中国期刊全文数据库、万方数据库、维普数据库、PubMed、Medline，并结合手工检索期刊。检索时间为1994年12月1日至2016年5月30日。纳入术前TACE对可切除性肝细胞癌围术期安全性影响的随机对照研究，试验组患者术前仅行TACE辅助治疗后行手术切除，对照组患者行一期手术切除。由2名研究者独立筛选文献和提取数据，并进行质量评价。计数资料采用相对危险度(RR)及95%可信区间(95%CI)表示。计量资料采用标准均数差(SMD)及95%CI表示。采用I2对异质性进行分析。
    结果:最终纳入符合标准的相关研究共5篇，均为随机对照研究，累计样本量430例，其中试验组212例，对照组218例。Meta分析结果显示：试验组和对照组可切除性肝细胞癌患者半肝切除率比较，差异无统计学意义(RR=0.99，95%CI：0.81～1.20，P>0.05)。与对照组比较，试验组可切除性肝细胞癌患者联合肝周脏器切除率升高，差异有统计学 意义(RR=3.42，95%CI：1.91～6.12，P<0.05)。亚组分析结果显示：与对照组比较，试验组肿瘤平均直径> 5 cm可切除性肝细胞癌患者手术时间延长、术后并发症发生率升高，差异均有统计学意义(SMD=0.31， RR=1.65，95%CI：0.06～0.57，1.01～2.69，P<0.05)。
    结论:术前行TACE对可切除性肝细胞癌手术切除范围并无显著影响，且提高联合肝周脏器切除率，增加肿瘤平均直径>5 cm可切除性肝细胞癌患者手术时间和术后并发症发生率，降低其围术期安全性。

     

    Abstract: Objective:To systematically evaluate the effect of preoperative transarterial chemoembolization (TACE) on perioperative safety of patients with resectable hepatocellular carcinoma (HCC).
    Methods:Literatures were researched using Chinese Journal Fulltext Database, Wanfang database, VIP database, PubMed, Medline from December 1, 1994 to May 30, 2016 with the key words including “肝细胞癌,肝切除,术前化疗栓塞,经动脉化疗栓塞, liver cancer, hepatocellular carcinoma, liver resection, hepatectomy, transcatheter arterial chemoembolization, transarterial chemoembolization, preoperative”. Manual retrieval was also conducted simultaneously. The randomized controlled trials (RCTs) about TACE on perioperative safety of patients with resectable HCC were received and enrolled. Patients undergoing surgery after preoperative TACE were allocated into the case group and patients undergoing firststage resection were allocated into the control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as relative risk (RR) and 95% confidence interval (CI). Measurement data were represented as standardized mean difference (SMD) and 95%CI. The heterogeneity of the studies was analyzed using the I2 test.
    Results:Five RCTs were enrolled in the Meta analysis, and the total sample size was 430 cases including 212 in the case group and 218 in the control group. Results of Meta analysis showed that there was no statistically significant difference in the hemihepatic resection rate between the 2 groups (RR=0.99, 95%CI: 0.81~1.20, P>0.05). The combined resection rate of perihepatic organs in the case group was significantly higher than that in the control group (RR=3.42, 95%CI: 1.91-6.12, P<0.05). Results of subgroup analysis showed that operation time and incidence of postoperative complications of patients with an average tumor diameter >5 cm in the case group were respectively longer and higher than these in the control group (SMD=0.31, RR=1.65, 95%CI: 0.06-0.57, 1.01-2.69, P<0.05).
    Conclusion:There is no obvious effect of preoperative TACE on resectable HCC, and it can evaluated combined resection rate of perihepatic organs, operation time and incidence of postoperative complications of patients with resectable HCC and an average tumor diameter > 5 cm, and also reduce the perioperative safety.

     

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