TACE联合肝切除术治疗原发性肝癌疗效的Meta分析

发布时间：2018-03-01 07:20

本文关键词： 原发性肝细胞肝癌肝切除 TACE Meta分析疗效生存率　出处：《遵义医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:术前预防性TACE及术后TACE能否改善可切除的原发性肝细胞肝癌患者临床疗效目前仍存在争议,本研究旨在通过Meta分析评价术前预防性TACE及术后TACE对可切除的原发性肝细胞肝癌患者的治疗价值。方法:计算机检索中文数据库中国生物医学文献数据库、中国知网、维普、万方数据库及外文数据库Pub Med、OVID、Embase、Cochrane library的相关文献,所有文献均截止于2016年1月。由两位评价员筛选、提取、核对数据,使用改良后的Jadad质量评分表对所纳入的随机对照试验进行文献质量评价,病例对照研究采用Newcastle-Ottawa?Scale文献质量评分表进行质量评估。对符合纳入标准的研究采用Stata12.0软件进行统计分析。结果:根据原发性肝细胞肝癌患者肝切除术前是否行预防性TACE分为术前预防性TACE联合切肝组(术前TACE组)和单独肝切除术组(LR组),两组的比较共纳入11篇文献,其中3篇随机对照试验(RCT)及8篇病例对照研究,共纳入2316例患者(术前预防性TACE联合切肝组752例,单独肝切除术1564例)。结果显示:术前预防性TACE联合切肝组与单独肝切除术组的比较手术时间、术中出血量均无显著性差异(手术时间:SMD=0.058,95%CI:-0.166,0.050,P=0.290;术中出血量:SMD=-0.098,95%CI:-0.204,-0.08,P=0.070),住院时间的比较差异有统计学意义(SMD=-0.86,95%CI:-1.57,-0.14,P=0.02),术前TACE住院时间明显增加。生存率:两组3年总体生存率与5年总体生存率的比较差异无统计学意义(3年总体生存率的比较:RR=1.039,95%CI:0.964,1.121,P=0.314;5年总体生存率的比较:RR=0.96,95%CI:0.86,1.08,P=0.505)。根据原发性肝细胞肝癌患者肝切除术后是否行TACE治疗分为术后TACE组与单独肝切除术组,两组的比较共纳入RCT1篇及病例对照研究14篇,共纳入2184例患者(肝切除术联合术后TACE组1097例,单独肝切除术1087例)。结果显示:HCC患者手术后TACE治疗能改善原发性肝细胞肝癌患者的1年总体生存率(1年总体生存率比较:RR=1.13,95%CI:1.03,1.24,P=0.010),本研究根据HCC患者的临床资料是否存在肿瘤直径大于5cm;多发结节;血管侵犯行亚组分析,结果显示手术后TACE治疗在伴有以上情况的分组中有重要的价值(亚组分析无危险因素组:RR=1.10,95%CI:0.97,1.25,P=0.140;伴危险因素组:RR=1.16,95%CI:1.02,1.32,P=0.028)。3年总体生存率的比较:手术后TACE治疗能显著改善原发性肝细胞肝癌患者的3年总体生存率(3年总体生存率的比较:RR=1.33,95%CI:1.15,1.53,P=0.000),手术后TACE治疗对改善原发性肝细胞肝癌患者5年总体生存率无明显作用(5年总体生存率的比较:RR=1.21,95%CI:0.95,1.15,P=0.124)。结论:1、HCC患者行术前TACE治疗不能缩短手术时间、降低术中出血量,延长了住院时间,对远期生存率亦无明显改善。2、HCC患者手术后TACE治疗能改善原发性肝细胞肝癌患者的1年、3年生存率,对HCC患者合并肿瘤直径大于5cm、多发结节、血管侵犯的情况下有重要的治疗价值,手术后行TACE可作为一种常规的治疗方式。
[Abstract]:Objective: whether preoperative prophylactic TACE and postoperative TACE can improve the clinical efficacy of resectable primary hepatocellular carcinoma (HCC) is still controversial. The purpose of this study was to evaluate the value of preoperative prophylactic TACE and postoperative TACE in the treatment of resectable primary hepatocellular carcinoma (HCC) by Meta analysis. The literature on Wanfang Database and Foreign language Database Pub library is as of January 2016. The data are screened, extracted and checked by two evaluators. The literature quality of the randomized controlled trial was evaluated using the improved Jadad quality scoring table, and the case control study was conducted using Newcastle-Ottawaa? Scale document quality score table was used to evaluate the quality. Stata12.0 software was used to analyze the quality of the patients who met the inclusion criteria. Results: according to whether preventive TACE was performed before hepatectomy in patients with primary hepatocellular carcinoma (HCC), preventive TACE was classified as preoperative prevention. Sex TACE combined with hepatectomy (TACE group) and hepatectomy alone group (LR group), the comparison of the two groups included 11 articles. Three randomized controlled trials (RCTs) and eight case-control studies were conducted in 2316 patients (752 patients with prophylactic TACE combined with hepatectomy before operation). The results showed that the operative time of preoperative prophylactic TACE combined with hepatectomy group was compared with that of single hepatectomy group. There was no significant difference in intraoperative bleeding volume (operation time: SMD-0.058% CI: -0.166% 0.050 / P0.290; intraoperative bleeding volume: SMD-0.09895 CI-0.204 ~ -0.08% P0.0700.The difference in hospitalization time was statistically significant (SMD-0.8695 CI-1 CI-1.57U -0.14P0.02), preoperative TACE hospitalization time was significantly increased. Survival rate: the overall survival rate of the two groups was 3 years and 5 years. There was no significant difference in the overall survival rate between the two groups. (comparison of 3-year overall survival rate: 1. 039% CI: 0. 964 + 1. 121% P0. 314; comparison of 5 year overall survival rates: 1: RR0. 96? 95 CI: 0. 866? 1. 08? P0. 5055.According to whether the patients with primary hepatocellular carcinoma were treated with TACE after hepatectomy, they were divided into postoperative TACE group and single hepatectomy group. The comparison between the two groups included 14 cases of RCT1 and 14 articles of case-control study. A total of 2184 patients (1097 cases of TACE group after hepatectomy and operation) were included in the study. The results showed that TACE could improve the 1-year overall survival rate of patients with primary hepatocellular carcinoma (HCC) after operation. The results showed that the 1-year overall survival rate of patients with primary hepatocellular carcinoma (HCC) was improved (1: 1. 13% 95% CI: 1.03% 1.24% P0.010%). This study was based on the clinical data of patients with HCC. Tumor diameter > 5 cm, multiple nodules; Subgroup analysis of vascular invasion, The results showed that TACE therapy after operation had important value in the subgroup with the above condition (subgroup analysis of non-risk factor group: RRN 1.1095 CI: 0.97: 1.25% P0. 140; with risk factors group 1. 1695 CI: 1.02n 1.32P0.0288.Compared with the 3-year overall survival rate, TACE treatment could significantly improve the primary survival rate. The 3-year overall survival rate of hepatocellular carcinoma (HCC) patients was 1.33 95% (CI: 1.15) 1.53% (P < 0.000). There was no significant effect of TACE treatment on the 5-year overall survival rate of patients with primary hepatocellular carcinoma after operation (comparison of 5-year overall survival rate: RRRN 1.21% 95: CI0.951.15P0. 1240.Conclusion: P < 0.05). Preoperative TACE treatment in patients with HCC did not shorten the operative time. Reducing the amount of intraoperative bleeding and prolonging the hospital stay did not significantly improve the long-term survival rate of patients with HCC. The 1-year and 3-year survival rates of patients with hepatocellular carcinoma were improved by TACE treatment. The diameter of the tumors in patients with HCC was more than 5 cm and the number of nodules was more than 5 cm. TACE can be used as a routine method for the treatment of vascular invasion.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7

【相似文献】