再次肝切除术与射频消融治疗亚洲复发性肝细胞癌患者效果比较的Meta分析

李旻骏; 邓柱鉴; 刘昊天; 滕煜宪; 霍荣瑞; 梁秀妹; 向邦德; 黎乐群; 钟鉴宏

doi:10.3969/j.issn.1001-5256.2021.05.025

再次肝切除术与射频消融治疗亚洲复发性肝细胞癌患者效果比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.05.025

广西医科大学附属肿瘤医院肝胆外科，广西肝癌诊疗工程技术研究中心，南宁 530021

基金项目:

国家自然科学基金 (82060510);

国家自然科学基金 (81960308);

广西自然科学基金 (2018GXNSFBA138018);

广西自然科学基金 (2018GXNSFAA050124);

广西自然科学基金 (桂科AB18126055);

“广西八桂学者”专项经费 (2019AQ20);

中国博士后科学基金 (2019M663876XB);

广西高等学校高水平创新团队及卓越学者计划

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：李旻骏、邓柱鉴、刘昊天、钟鉴宏负责课题设计，资料分析，撰写论文；邓柱鉴、刘昊天、滕煜宪、梁秀妹参与收集数据，修改论文；霍荣瑞负责数据统计；向邦德、黎乐群、钟鉴宏负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
李旻骏(1997—)，男，主要从事肝癌的研究

邓柱鉴(1996—)，男，主要从事肝癌的研究

通信作者:
钟鉴宏，zhongjianhong@gxmu.edu.cn

二者对本文贡献相同，同为第一作者

中图分类号: R735.7
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-30
- 录用日期: 2020-12-10
- 出版日期: 2021-05-20

Clinical effect of re-hepatic resection versus radiofrequency ablation in treatment of recurrent hepatocellular carcinoma in Asia: A Meta-analysis

Department of Hepatobiliary Surgery, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Guangxi Medical University Cancer Hospital, Nanning 530021, China

Research funding:

(82060510);

(81960308);

(2018GXNSFBA138018);

(2018GXNSFAA050124);

(桂科AB18126055);

(2019AQ20);

(2019M663876XB);

摘要

摘要: 目的使用Meta分析的方法比较再次肝切除术与射频消融治疗亚洲复发性肝癌患者的安全性与疗效。方法系统检索PubMed、中国知网和万方数据库，日期自建库截止至2020年6月15日。由两位评价者独立检索并提取数据，采用RevMan 5.4.1软件进行Meta分析。结果共2项随机对照试验和18项回顾性队列研究符合纳入标准，均来自亚洲国家，包含2903例复发性肝癌患者。再次肝切除术组和射频消融组患者围手术期病死率分别为2%和0，围手术期并发症发生率分别为22.4%和3.3%。再次肝切除术组和射频消融组患者术后1、3、5年总生存率分别为92.3%、66.3%、51.1%和91.4%、69.2%、39.9%。两组患者术后1、3、5年无瘤生存率分别为67.9%、48.3%、34.4%和57.5%、27.9%、14.0%。Meta分析结果提示，两组患者的总生存率差异无统计学意义(HR=0.89，95%CI：0.77~1.02，P=0.10)，但再次肝切除术组患者的无瘤生存率显著高于射频消融组(HR=0.79，95%CI：0.72~0.87，P＜0.001)。结论目前证据显示，再次肝切除术治疗复发性肝癌有更高的无瘤生存率，但两组患者的总生存率相似。
- 癌，肝细胞 /
- 肝切除术 /
- 射频消融 /
- Meta分析(主题)
Abstract: Objective To investigate the safety and efficacy of re-hepatic resection (rHR) versus radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (RHCC) in Asia through a meta-analysis. Methods PubMed, CNKI, and Wanfang Data were searched for related studies published up to June 15, 2020. Two reviewers independently searched for the articles and extracted related data, and RevMan 5.4.1 was used to perform the meta-analysis. Results A total of 2 randomized controlled trials and 18 retrospective cohort studies met the inclusion criteria and involved 2903 patients with RHCC from Asian countries. The mortality rate in the perioperative period was 2% in the rHR group and 0 in the RFA group, and the incidence rate of perioperative complications was 22.4% in the rHR group and 3.3% in the RFA group. The 1-, 3-, and 5-year overall survival rates were 92.3%, 66.3%, and 51.1%, respectively, in the rHR group and 91.4%, 69.2%, and 39.9%, respectively, in the RFA group. The 1-, 3-, and 5-year disease-free survival rates were 67.9%, 48.3%, and 34.4%, respectively, in the rHR group and 57.5%, 27.9%, and 14.0%, respectively, in the RFA group. The Meta-analysis showed that there was no significant difference in overall survival rate between the two groups (hazard ratio [HR]=0.89, 95% confidence interval [CI]: 0.77-1.02, P=0.10), while the rHR group had a significantly higher disease-free survival rate than the RFA group (HR=0.79, 95% CI: 0.72-0.87, P < 0.001). Conclusion Current evidence shows that rHR may help to achieve a higher disease-free survival rate than RFA in the treatment of RHCC, while rHR and RFA have a similar overall survival rate.
- Carcinoma, Hepatocellular /
- Hepatectomy /
- Radiofrequency Ablation /
- Meta-Analysis as Topic

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图 1 文献检索流程图

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图 2 再次肝切除术和RFA治疗复发性肝癌患者OS的比较

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图 3 再次肝切除术和RFA治疗复发性肝癌患者RFS的比较

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图 4 再次肝切除术和RFA治疗复发性肝癌患者OS及RFS HR的发表偏倚分析

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表 1 纳入研究的基线特点

第一作者和年份	国家/地区	纳入时间(年)	组别	样本量	男/女(例)	年龄(岁)	单个/多个肿瘤(例)	复发肿瘤直径(cm)	肝硬化[例(%)]	CTP分级(A/B/C，例)	随访(月)
Wang 2015^[3]	中国	2004—2010	肝切除	128	113/15	50.2±10.1	89/39	2.4±0.9	66(51.6)	-	-
			RFA	162	148/14	52.7±10.9	107/55	2.3±0.7	-	-	-
Sun 2017^[4]	中国台湾	2002—2014	肝切除	43	34/9	60(35~76)	-	1.9(0.8~3.0)	36(83.7)	42/1	53
			RFA	57	38/19	63(27~81)	-	1.8(1.0~3.0)	50(87.7)	57/0	54
Umeda 2011^[5]	日本	1998—2007	肝切除	29	-	-	-	3.20±0.57	-	29/0	48
			RFA	58	-	-	-	2.1±0.3	-	51/7	48
Song 2015^[6]	韩国	1994—2012	肝切除	39	31/8	52.5±9.8	32/7	2.2±1.1	23(59)	39/0	36.3(0.8~126.6)
			RFA	178	145/33	55.4±10.6	156/22	1.7±0.6	130(73.0)	172/6	44.7(5.6~139.8)
Liang 2008^[7]	中国	1999—2007	肝切除	44	39/5	48.8±12.0	34/10	≤3 (26)	-	44/0	33.5±24.1
			RFA	66	54/12	54.6±10.8	48/18	≤3 (44)	-	64/2	21.1±19.1
Ho 2012^[8]	中国台湾	2001—2007	肝切除	54	40/14	56.3±12.3	-	2.9±1.8	26(48.1)	51/2/1	32(0~79)
			RFA	50	39/11	61.0±11.1	-	2.3±1.9	28(56.0)	50/0	27(0~96)
Chan 2012^[9]	中国香港	2001—2008	肝切除	29	-	52(38~79)	21/8	2.1(0.8~5.5)	25(86.2)	29/0	44.9
			RFA	45	-	59(36~80)	29/16	2.2(0.8~6.0)	40(88.9)	40/5	44.9
Chen 2018^[10]	中国	2009—2015	肝切除	48	41/7	73.5±3.5	28/20	2.6±1.1	41(85.4)	39/9	36.9(2~78)
			RFA	57	51/6	73.7±2.9	30/27	2.5±1.2	49(86.0)	45/12	37.3(2~78)
岑峰2016^[11]	中国	2011—2015	肝切除	28	22/6	53.6	12/16	-	23(82.1)	18/10	-
			RFA	24	19/5	55.7	10/14	-	19(79.2)	-	-
陈康2019^[12]	中国	2005—2014	肝切除	77	65/12	-	-	-	57(74)	76/1	57(2~168)
			RFA	82	72/10	-	-	-	50(61)	77/5	51(4~111)
黄新辉2013^[13]	中国	2007—2011	肝切除	66	51/15	50.5±10.1	66/0	2.9±1.1	57(86.3)	66/0	-
			RFA	46	36/10	54.1±12.1	46/0	2.6±0.9	39(84.8)	46/0	-
梁惠宏2011^[14]	中国	1999—2009	肝切除	72	65/7	49±12	72/0	2.1±0.1	-	70/2	36±25
			RFA	79	69/10	55±11	79/0	2.5±0.1	-	73/6	32±21
任正刚2008^[15]	中国	2000—2005	肝切除	145	127/18	51	127/18	2.0	-	145/0	23(3~88)
			RFA	68	64/4	52	52/16	2.0	-	68/0	23(3~88)
田正灵2016^[16]	中国	2012—2015	肝切除	30	28/2	48.8±9.6	24/6	-	24(80)	-	17(6.0~42.5)
			RFA	27	26/1	50.9±10.1	19/8	-	23(85.2)	-	17(6.0~42.5)
张辉2013^[17]	中国	2003—2011	肝切除	69	-	-	-	3.5	61(88.4)	54/15	-
			RFA	99	-		-	2.1	76(76.8)	71/28	-
张婷婷2014^[18]	中国	1998—2010	肝切除	27	25/2	47±13	25/2	3.2±1.1	-	27/0	32(9~118)
			RFA	39	37/2	52±13	37/2	2.7±1.1	-	37/2	28(2~79)
Peng 2018^[19]	中国	2006—2015	肝切除	79	67/2	55	59/20	≤3(48)	-	-	53.2(4~96)
			RFA	107	95/12	57	75/32	≤3(73)	-	-	52.3(3~96)
Lu 2020^[20]	中国	2004—2015	肝切除	138	124/16	50.1±10.9	112/26	2.8±1.9	96(70)	138/0	37.6
			RFA	194	172/22	52.9±11.8	162/32	1.9±0.9	134(69)	194/0	41.6
Xia 2019^[21]	中国	2010—2013	肝切除	120	107/13	52.4(25.7~60.5)	96/24	2.9(1.0~5.0)	50(41.7)	120/0	44.3(4.3~90.6)
			RFA	120	109/11	53.5(28.0~59.9)	94/26	2.7(1.0~4.8)	55(45.8)	120/0	44.3(4.3~90.6)
刘嘉龙2019^[22]	中国	2016—2017	肝切除	39	38/1	50.0±10.0	37/2	2.1±0.7	37(94.9)	38/1	24
			RFA	41	37/4	48.9±11.3	39/2	1.8±0.8	39(95.1)	39/2	24
注：-，未报道。

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表 2 纳入患者的治疗结局

第一作者和年份	组别	并发症发生率(%)	围手术期病死率(%)	复发[例(%)]	RFS				OS
第一作者和年份	组别	并发症发生率(%)	围手术期病死率(%)	复发[例(%)]	1年	3年	5年	P值¹⁾	1年	3年	5年	P值¹⁾
Wang 2015^[3]	肝切除	-	-	-	-	-	-	-	97.7	84.1	64.5	＜0.001
	RFA	-	-	-	-	-	-		96.9	73.4	37.0
Sun 2017^[4]	肝切除	16	2	30(69.8)	57.0	32.1	28.6	0.89	97.6	82.7	56.4	0.69
	RFA	7	0	41(71.9)	60.8	26.6	16.6		98.2	77.2	52.6
Umeda 2011^[5]	肝切除	-	-	-	-	-	-	-	93.1	66.8	58.1	0.899
	RFA	-	-	-	-	-	-		94.7	75.1	48.3
Song 2015^[6]	肝切除	64	2.6	18(46.2)	66.1	48.5	43.1	0.834	88.8	88.8	83.9	0.686
	RFA	2.2	0	117(65.7)	70.1	40.8	30.0		98.9	82.5	71.0
Liang 2008^[7]	肝切除	68.2	0	86.4	-	-	-	-	78.6	44.5	27.6	0.79
	RFA	3.0	0	78.8	-	-	-		76.6	48.6	39.9
Ho 2012^[8]	肝切除	-	-	-	-	-	-	-	-	-	72.0	-
	RFA	-	-	-	-	-	-		-	-	83.0
Chan 2012^[9]	肝切除	24.1	0	21(72.4)	41.1	24.2	24.2	0.14	89.7	56.5	35.2	0.51
	RFA	2.2	2.2	38(84.4)	32.2	12.4	9.3		83.7	43.1	29.1
Chen 2018^[10]	肝切除	25	2.1	26(54.2)	73.1	49.7	40.7	0.465	76.3	52.5	42.6	0.413
	RFA	0	0	27(47.4)	69.5	37.8	33.1		78.2	40.8	36.7
岑峰2016^[11]	肝切除	50	0	-	46.4	0	0	-	-	-	-	-
	RFA	-	0	-	20.8	0	0		-	-	-
陈康2019^[12]	肝切除	17.1	1.3	-	-	-	-	-	88.8	68.8	51.1	0.258
	RFA	9.8	0	-	-	-	-		91.4	73.4	61.1
黄新辉2013^[13]	肝切除	18.1	0	-	43.9	14.4	8.2	0.548	89.5	54.3	28.8	0.780
	RFA	0	0	-	56.9	12.4	5.0		82.6	50.8	20.5
梁惠宏2011^[14]	肝切除	36	0	≤1年: 39＞1年: 33	-	-	-	-	95.3	65.7	54.5	＞0.05
	RFA	13	0	≤1年: 37＞1年: 42	-	-	-	－	100	79.4	62.1
任正刚2008^[15]	肝切除	5.5	0	≤2年: 71＞2年: 74	79.4	48.1	34.4	0.001	88.1	62.6	41.0	0.693
	RFA	1.5	0	≤2年: 37＞2年: 31	58.0	27.8	12.4		94.7	65.1	37.3
田正灵2016^[16]	肝切除	6.7	0	10(33.3)	73.3	64.3	-	0.002	96.7	93.3	-	0.54
	RFA	3.7	0	24(88.9)	46.7	26.7	-		96.3	84.0	-
张辉2013^[17]	肝切除	15.9	1.45	-	-	-	-	-	68.2	45.4	-	＞0.05
	RFA	0	0	-	-	-	-		73.7	53.6	-
张婷婷2014^[18]	肝切除	-	0	22(56.4)	66.7	50.7	43.4	0.323	96.2	76.9	61.2	0.471
	RFA	-	0	14(52.9)	65.8	28.0	14.0		86.2	73.3	62.2
Peng 2018^[19]	肝切除	17.7	1.3	-	64.8	41.6	38.3	0.258	84.8	60.2	51.9	0.871
	RFA	4.7	0	-	58.2	35.2	29.6		84.6	66.9	49.1
Lu 2020^[20]	肝切除	-	-	-	91.8	82.0	72.9	0.38	-	-	-	-
	RFA	-	-	-	94.4	75.4	61.7		-	-	-
Xia 2019^[21]	肝切除	22.4	0	60.8	85.0	52.4	36.2	0.09	92.5	65.8	43.6	0.17
	RFA	7.3	0	64.2	74.2	41.7	30.2		87.5	52.5	38.5
刘嘉龙2019^[22]	肝切除	35.9	0	19(48.7)	69.2	-	-	＜0.001	92.3	-	-	0.292
	RFA	4.9	0	32(78.0)	26.8	-	-		85.4	-	-
注：-，未报道；1) P值来源于原文报道。

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