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微波消融与手术切除治疗肝细胞癌合并肝硬化效果及安全性的Meta分析

骆建兴 张扬 向讷 扈晓宇

引用本文:
Citation:

微波消融与手术切除治疗肝细胞癌合并肝硬化效果及安全性的Meta分析

DOI: 10.12449/JCH240915
基金项目: 

成都中医药大学附属医院科技基金项目 (21YY03)

利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:骆建兴、扈晓宇负责课题设计,资料分析,撰写论文;张扬、向讷参与收集数据,修改论文;扈晓宇负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    扈晓宇, xiaoyuhu@aliyun.com (ORCID: 0000-0003-0187-4386)

Efficacy and safety of microwave ablation versus hepatic resection in treatment of hepatocellular carcinoma with liver cirrhosis: A Meta-analysis

Research funding: 

Science and Technology Foundation Project of Hospital of Chengdu University of Traditional Chinese Medicine (21YY03)

More Information
  • 摘要:   目的  通过Meta分析系统评价微波消融(MWA)和手术切除(HR)在肝细胞癌(HCC)合并肝硬化中的有效性及安全性。  方法  本研究根据PRISMA指南完成,PROSPERO注册号:CRD42024509185。检索PubMed、Cochrane Library、EMBASE、Web of Science、中国知网、维普、万方数据库,时间均为从建库至2023年11月,搜索MWA对比HR治疗HCC合并肝硬化的随机对照试验(RCT)和队列研究,采用Stata 12.0软件进行Meta分析。  结果  共纳入3项RCT和5项回顾性队列研究,共953例患者。Meta分析显示:MWA的1/2/3/5年总生存率(OS)与HR相比无统计学差异(P值均>0.05)。MWA的1/2/5年复发率与HR相比无统计学差异(P值均>0.05)。MWA的3年复发率高于HR(RR=1.59,95%CI:1.08~2.33,P=0.017)。MWA的1/3/5年无复发生存率(DFS)低于HR(RR=0.94,95%CI:0.89~0.99,P=0.018,I2=0.0%;RR=0.84,95%CI:0.72~0.98,P=0.023,I2=25.4%;RR=0.75,95%CI:0.58~0.98,P=0.032,I2=34.6%)。但亚组分析表明,在RCT组,MWA的1/2/3年OS和1/3年DFS与HR相比无统计学差异(P值均>0.05)。MWA的术中出血量、手术时间、住院时间、不良反应及肝功能均优于HR(SMD=-2.31,95%CI:-2.64~-1.97,P<0.001,I2=3.1%;SMD=-3.38,95%CI:-4.05~-2.71,P<0.001,I2=73.8%;SMD=-2.54,95%CI:-3.27~-1.80,P<0.001,I2=92.8%;RR=0.42,95%CI:0.30~0.59,P<0.001,I2=0.0%;SMD=-1.43,95%CI:-1.89~-0.97,P<0.001)。  结论  MWA与HR在局部复发、DFS及OS方面无明显差异。MWA术中出血量更少,手术时间更短,不良反应更少,对肝功能影响更小,住院时间更短。

     

  • 图  1  文献筛选流程图

    Figure  1.  Literature screening flow chart

    图  2  OS森林图

    注: a,1年OS;b,2年OS;c,3年OS;d,5年OS。

    Figure  2.  Forest plots of OS

    图  3  LR和DFS森林图

    注: a,1年LR;b,1年DFS;c,3年DFS;d,5年DFS。

    Figure  3.  Forest plots of LR and DFS

    图  4  肝功能森林图

    注: a,ALT; b,AST; c,Alb。

    Figure  4.  Forest plots of liver function

    图  5  不良反应及手术相关指标森林图

    注: a,不良反应;b,术中出血量;c,手术时间;d,住院时间。

    Figure  5.  Forest plots of adverse reaction and operation related indexes

    表  1  纳入文献的基本特征

    Table  1.   The characteristics of studies

    纳入研究 国家

    例数

    (T/C)

    研究类型

    年龄(岁)

    (T/C)

    男女比例

    (T/C)

    MWA方式 HBsAg阳性率(T/C,%) Child-Pugh分级 肿瘤个数及大小(cm) 随访时间(月) 结局指标 NOS(分)
    Zhang等201724 中国 31/42 RCS

    51.2±6.93/

    54.1±7.23

    20∶11/

    29∶13

    PMWA 45.2/61.9 A或B 单发且直径≤5或3个且最大直径≤3 >60 ①④ 6
    Zhang等201625 中国 68/122 RCS

    55.4±9.9/

    49.5±8.6

    57∶11/

    111∶11

    PMWA 92.6/91.8 A 单个且直径<3 9~104 ①②③④⑧ 7
    杨藩等201626 中国 98/152 RCS

    55.4±7.9/

    52.5±8.0

    82∶16/

    133∶19

    PMWA 91.8/91.4 A或B 单发且直径≤3 9~96 ①③④⑧ 8
    黄炎等201727 中国 26/24 RCS

    57.6±6.0/

    58.1±5.5

    15∶11/

    15∶9

    LMWA - A或B 2.36±0.41/2.46±0.36;个数≤2 13~63/16~65 ①②④⑤⑥⑦⑧ 8
    廖凌峰等201828 中国 40/68 RCT

    52.36±8.62/

    52.20±8.60

    28∶12/

    50∶18

    PMWA 90.00/88.24 A或B

    2.32±0.64/

    2.12±0.60

    12~36 ①③④
    陈红健等201829 中国 46/46 RCT 29~78 68∶24 UNK 100 A或B 单发且直径≤3或2个且直径之和≤3 24 ①④⑤⑥⑦⑧
    王辉坡等201930 中国 45/45 RCT

    53.8±3.2/

    54.3±2.9

    23∶22/

    18∶27

    UNK - - - - ⑥⑦⑧
    黄志明等201631 中国 47/53 RCS

    60.0±12.4/

    55.8±11.3

    42∶5/

    48∶5

    UNK - A或B 单发且直径≤3或3个且最大直径≤3 3~44 ①②④⑥⑧ 9

    注:T,MWA组;C,HR组;UNK,未分类或未确定。①OS;②LR;③DFS;④不良反应;⑤肝功能;⑥手术时间;⑦术中出血量;⑧住院时间。-,未提供数据。

    下载: 导出CSV

    表  2  消融方式的亚组分析

    Table  2.   Subgroup analysis-method of ablation

    亚组 结局指标 纳入研究数量 效应值[RRSMD (95%CI)] 异质性(I2 P 优势组
    PMWA 1年OS 4 0.99(0.96~1.01) 0.0% 0.326
    2年OS 1 0.94(0.83~1.08) 0.406
    3年OS 4 0.93(0.97~1.00) 0.0% 0.067
    1年LR 1 1.79(0.46~6.95) 0.397
    不良反应 4 0.44(0.29~0.66) 24.0% <0.001 MWA
    住院时间 2 -2.33(-2.84~-1.82) 75.4% <0.001 MWA
    LMWA 1年OS 1 - -
    2年OS 1 0.97(0.80~1.16) 0.704
    3年OS 1 0.97(0.75~1.26) 0.813
    ALT 1 -0.99(-1.58~-0.40) 0.001 MWA
    AST 1 -0.88(-1.46~-0.30) 0.003 MWA
    Alb 1 1.97(1.29~2.65) <0.001 MWA
    不良反应 1 0.42(0.17~1.03) 0.059
    手术时间 1 -2.62(-3.39~-1.86) <0.001 MWA
    住院时间 1 -2.25(-2.97~-1.54) <0.001 MWA
    术中出血量 1 -1.89(-2.56~-1.22) <0.001 MWA
    未分类 1年OS 2 0.98(0.91~1.07) 0.0% 0.711
    2年OS 2 0.95(0.83~1.10) 0.0% 0.529
    1年LR 1 1.25(0.43~3.59) 0.683
    ALT 1 -3.06(-3.67~-2.45) <0.001 MWA
    AST 1 -6.48(-7.51~-5.45) <0.001 MWA
    Alb 1 0.30(-0.11~0.71) 0.153
    不良反应 2 0.33(0.14~0.77) 0.0% 0.011 MWA
    手术时间 3 -3.61(-4.34~-2.89) 71.8% <0.001 MWA
    住院时间 3 -2.82(-4.73~-0.90) 96.9% 0.004 MWA
    术中出血量 2 -2.45(-2.83~-2.06) 0.0% <0.001 MWA
    下载: 导出CSV

    表  3  研究类型的亚组分析

    Table  3.   Subgroup analysis-type of research

    亚组 结局指标 纳入研究数量 效应值[RRSMD (95%CI)] 异质性(I2 P 优势组
    RCT 1年OS 2 0.97(0.91~1.04) 0.0% 0.437
    2年OS 2 0.95(0.85~1.06) 0.0% 0.324
    3年OS 1 1.02(0.74~1.41) 0.904
    1年DFS 1 0.92(0.81~1.04) 0.175
    3年DFS 1 1.05(0.64~1.70) 0.855
    ALT 1 -3.06(-3.67~-2.45) <0.001 MWA
    AST 1 -6.48(-7.51~-5.45) <0.001 MWA
    Alb 1 0.30(-0.11~0.71) 0.153
    不良反应 2 0.36(0.15~0.90) 20.4% 0.029 MWA
    手术时间 2 -3.93(-4.67~-3.19) 53.2% <0.001 MWA
    术中出血量 2 -2.45(-2.83~-2.06) 0.0% <0.001 MWA
    住院时间 2 -3.69(-5.17~-2.20) 89.1% <0.001 MWA
    RCS 1年OS 5 0.99(0.96~1.02) 0.0% 0.495
    2年OS 2 0.96(0.83~1.13) 0.0% 0.652
    3年OS 4 0.93(0.87~0.99) 0.0% 0.026 HR
    1年DFS 2 0.95(0.89~1.00) 0.0% 0.050
    3年DFS 2 0.81(0.69~0.95) 45.4% 0.009 HR
    ALT 1 -0.99(-1.58~-0.40) 0.001 MWA
    AST 1 -0.88(-1.46~-0.30) 0.003 MWA
    Alb 1 1.97(1.29~2.65) <0.001 MWA
    不良反应 5 0.43(0.29~0.62) 0.0% <0.001 MWA
    手术时间 2 -2.88(-3.34~-2.42) 0.0% <0.001 MWA
    术中出血量 1 -1.89(-2.56~-1.22) <0.001 MWA
    住院时间 4 -2.00(-2.65~-1.35) 89.1% <0.001 MWA
    下载: 导出CSV
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  • 收稿日期:  2024-02-18
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