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目的通过Meta分析比较射频消融(radiofrequency ablation,RFA)联合肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)与手术切除(surgical resection,SR)治疗早期原发性肝细胞癌(hepatocellular carcinoma,HCC)的临床疗效。方法通过PubMed、Embase和Medline等外文数据库,及CNKI、维普和万方数据库等中文数据库,检索国内外2013-12-31以前关于比较RFA+TACE与SR治疗早期HCC的病例对照临床试验的文献,根据纳入标准对总体生存率(overall survival rate,OS)、无病生存率(disease-free survival rate,DFS)及术后主要并发症发生率均有详细的分析描述。利用评价指标优势比(OR)及95%可信区间(95%CI)在固定效应模式或随机效应模式下对数据进行合并分析,所有数据均采用Cochrance协作网提供的Revman 4.2软件及Stata 12.0软件进行分析。结果纳入4篇病例对照研究,共697例患者。Meta分析结果显示,手术治疗组5年OS及3和5年DFS明显高于联合治疗组,OR及95%CI分别为0.50(0.32~0.79)、0.66(0.45~0.97)和0.37(0.19~0.72),P值分别为0.003、0.03和0.003;而1、3年OS及1年DFS差异无统计学意义,OR及95%CI分别为1.50(0.77~2.92)、0.94(0.64~1.37)和1.23(0.79~1.90),P值分别为0.23、0.74和0.36。联合治疗组的主要术后并发症发生率低于手术治疗组,OR=0.29,95%CI:0.10~0.78,P=0.01。结论对于早期肝细胞癌,虽然联合治疗术后并发症明显小于手术治疗,但手术治疗的总体疗效仍优与联合治疗。
Objective To compare the clinical efficacy of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) and surgical resection (SR) in the treatment of early hepatocellular carcinoma (HCC) by Meta-analysis Efficacy. Methods The Chinese and foreign literatures about case-control clinical trials comparing RFA + TACE and SR in the treatment of early stage HCC were retrieved from Chinese and foreign databases such as PubMed, Embase, Medline and other foreign databases and CNKI, VIP and Wanfang database, The overall survival rate (OS), disease-free survival rate (DFS) and the incidence of postoperative major complications were analyzed and described in detail according to the inclusion criteria. Data were analyzed using the OR (odds ratio) and 95% confidence interval (95% CI) in the fixed-effects or random-effects modes, all using Revman 4.2 software and Stata 12.0 software from Cochrance Collaboration Analyze. Results Four case-control studies were included, with a total of 697 patients. Meta-analysis showed that the 5-year OS and the 3-and 5-year DFS in the surgical treatment group were significantly higher than those in the combined treatment group. The OR and 95% CI were 0.50 (0.32-0.79), 0.66 (0.45-0.97) and 0.37 (0.19-0.72 ), Respectively. The P values were 0.003, 0.03 and 0.003, respectively. There was no significant difference between 1 and 3 years OS and 1 year DFS. OR and 95% CI were 1.50 (0.77-2.92), 0.94 (0.64-1.37) and 1.23 (0.79-1.90), P values were 0.23, 0.74 and 0.36, respectively. The incidence of postoperative complications in the combination therapy group was lower than that in the surgery group (OR = 0.29, 95% CI: 0.10-0.78, P = 0.01). Conclusion For early hepatocellular carcinoma, although the postoperative complications of combination therapy are significantly less than the surgical treatment, the overall effect of surgical treatment is still excellent and combined treatment.