CalliSpheres载药微球与传统经肝动脉化疗栓塞术治疗肝细胞癌效果和安全性比较的Meta分析

彭一晟; 何攀; 朱刚; 李昕楷; 谭顺德; 陈健飞; 凡军; 罗斌; 苏松; 李波; 杨小李

doi:10.3969/j.issn.1001-5256.2021.08.019

CalliSpheres载药微球与传统经肝动脉化疗栓塞术治疗肝细胞癌效果和安全性比较的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.08.019

彭一晟^{a, b, c},
何攀^{a, b, c},
朱刚^a,
李昕楷^a,
谭顺德^a,
陈健飞^a,
凡军^a,
罗斌^{a, b, c},
苏松^{a, b, c},
李波^{a, b, c},
杨小李^{a, b, c, ,}

a.
西南医科大学附属医院普通外科(肝胆)，四川沪州 646000
b.
西南医科大学附属医院核医学与分子影像四川省重点实验室，四川沪州 646000
c.
西南医科大学附属医院四川省院士(专家)工作站，四川沪州 646000

基金项目:

国家自然科学基金 (81802778);

成都高新区医学会2020年度肿瘤介入专项科研基金 (2020S02)

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: 彭一晟、何攀负责资料分析, 撰写论文; 朱刚、李昕楷、谭顺德、陈健飞参与收集数据, 修改论文; 凡军、罗斌、苏松负责拟定写作思路及数据分析; 李波、杨小李负责课题设计, 指导撰写文章并最后定稿。

详细信息

通信作者:
杨小李, 344920646@qq.com

中图分类号: R735.7
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出版历程
- 收稿日期: 2020-12-16
- 录用日期: 2021-01-19
- 出版日期: 2021-08-20

Efficacy and safety of CalliSpheres microsphere versus conventional transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma: A Meta-analysis

Yisheng PENG^{a, b, c},
Pan HE^{a, b, c},
Gang ZHU^a,
Xinkai LI^a,
Shunde TAN^a,
Jianfei CHEN^a,
Jun FAN^a,
Bin LUO^{a, b, c},
Song SU^{a, b, c},
Bo LI^{a, b, c},
Xiaoli YANG^{a, b, c
, ,}

a.
Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
b.
Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
c.
Academician (Expert) Working of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

National Natural Science Foundation of China (81802778);

Chengdu High-tech Zone Medical Association 2020 Special Research Fund for Interventional Cancer (2020S02)

摘要

摘要: 目的本研究旨在通过Meta分析比较CalliSpheres载药微球经肝动脉化疗栓塞术(CSM-TACE)与传统经肝动脉化疗栓塞术(cTACE)治疗肝细胞癌的有效性和安全性。方法系统的检索PubMed、Web Science、Cochrane Library、中国知网数据库、万方数据库和维普数据库, 比较CSM-TACE与cTACE在肝细胞癌中应用的所有中英文文献, 截止日期到2020年10月。对纳入文献进行质量学评价后, 采用Cochrane Library提供的RevMan 5.3软件进行分析。结果经筛选后共纳入15篇研究, 包括1535例患者。Meta分析显示, 接受CSM-TACE治疗的患者1年总生存率(OR=2.26, 95%CI: 1.63~3.13, P＜0.000 01)、2年总生存率(OR=1.73, 95%CI: 1.20~2.50, P=0.003) 和2年无进展生存率(OR=1.60, 95%CI: 1.05~2.43, P=0.03)显著高于接受cTACE治疗的患者。而且在安全性方面, 接受CSM-TACE治疗的患者术后呕吐率(OR=0.65, 95%CI: 0.46~0.92, P=0.01)、骨髓抑制率(OR=0.17, 95%CI: 0.05~0.54, P=0.003)、粒细胞减少率(OR=0.18, 95%CI: 0.07~0.45, P=0.000 3)均明显低于接受cTACE治疗的患者, 在术后发热率、腹痛率、腹水率方面两组差异均无统计学意义(P值均＞0.05)。结论 CSM-TACE在提高1年和2年总生存率以及2年无进展生存率方面具有显著优势, 而且可明显降低患者术后呕吐率、骨髓抑制率、粒细胞减少率。因此, CSM-TACE是一种安全、有效的治疗方式。
- 癌, 肝细胞 /
- 微球体 /
- 化学栓塞, 治疗性 /
- Meta分析(主题)
Abstract: Objective To investigate the efficacy and safety of CalliSpheres microsphere-transcatheter arterial chemoembolization (CSM-TACE) versus conventional transcatheter arterial chemoembolization (cTACE) in the treatment of hepatocellular carcinoma (HCC) through a meta-analysis. Methods PubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for all Chinese and English articles on the application of CSM-TACE and cTACE in HCC published up to the end of October, 2020. After quality assessment was performed for the articles included, RevMan 5.3 software provided by Cochrane Library was used for analysis. Results A total of 15 studies were included, with 1535 patients in total. This meta-analysis showed that compared with the patients receiving cTACE, the patients receiving CSM-TACE had significantly higher 1-year overall survival rate (odds ratio [OR]=2.26, 95% confidence interval [CI]: 1.63-3.13, P < 0.000 01), 2-year overall survival rate (OR=1.73, 95%CI: 1.20-2.50, P=0.003), and 2-year progression-free survival rate (OR=1.60, 95%CI: 1.05-2.43, P=0.03). In terms of safety, compared with the patients receiving cTACE, the patients receiving CSM-TACE had significantly lower incidence rates of postoperative vomiting (OR=0.65, 95%CI: 0.46-0.92, P=0.01), bone marrow suppression (OR=0.17, 95%CI: 0.05-0.54, P=0.003), and neutropenia (OR=0.18, 95%CI: 0.07-0.45, P=0.000 3), while there were no significant differences between the two groups of patients in postoperative pyrexia, abdominal pain, and ascites (all P > 0.05). Conclusion CSM-TACE has significant advantages in improving 1- and 2-year overall survival rates and 2-year progression-free survival rates and can significantly reduce the incidence rates of postoperative vomiting, bone marrow suppression, and neutropenia. Therefore, CSM-TACE is a safe and effective treatment method.
- Carcinoma, Hepatocellular /
- Microspheres /
- Chemoembolization, Therapeutic /
- Meta-Analysis as Topic

HTML全文

图 1 文献检索流程图

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图 2 2组总生存率的Meta分析

注: a, 1年总生存率; b, 2年总生存率。

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图 3 2组无进展生存率的Meta分析

注: a, 1年无进展生存率; b, 2年无进展生存率。

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图 4 2组术后发热率的Meta分析

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图 5 2组术后腹痛率的Meta分析

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图 6 2组术后呕吐率的Meta分析

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图 7 2组术后腹水率的Meta分析

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图 8 2组术后骨髓抑制的Meta分析

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图 9 2组术后粒细胞减少的Meta分析

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图 10 发表偏倚分析

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表 1 纳入文献的基本特征及质量评价

第一作者	治疗	样本量(例)	研究时间(年)	研究类型	性别(男/女, 例)	BCLC分期(A/B/C+D, 例)	肿瘤大小(cm)	PVTT (是/否, 例)	Child-Pugh分级(A/B/C, 例)	结果	NOS评分
Wu 2018^[9]	CSM-TACE	24	2016—2017	回顾性	22/2	0/13/11	7.25±2.3	NA	10/14/0	⑥⑦⑧	7
	cTACE	30			27/3	0/17/13	7.53±2.3	NA	16/14/0
黄文浩2020^[10]	CSM-TACE	48	2017—2019	回顾性	35/13	17/25/6	NA	NA	28/20/0	③④⑤	8
	cTACE	56			40/16	21/27/8			31/25/0
Ma 2019^[13]	CSM-TACE	94	NA	回顾性	78/16	22/32/40	9.6±1.4	35/59	69/24/1	①②③④	9
	cTACE	98			87/11	23/40/35	7.5±1.2	29/69	75/22/1
Zhang 2019^[14]	CSM-TACE	56	2013— 2017	回顾性	45/11	0/8/48	11.2±6.6	47/9	36/20/0	③④⑤	8
	cTACE	33			28/5	0/5/28	10.7±5.8	27/6	23/10/0
Xiao 2019^[15]	CSM-TACE	26	2010— 2016	回顾性	22/4	0/13/13	9.7±3.8	11/14	20/6/0	①③④⑤	8
	cTACE	32			27/5	0/15/17	10.8±5.9	13/19	21/11/0
Xiang 2019^[16]	CSM-TACE	36	2015— 2017	回顾性	31/5	9/17/10	5.5±1.4	9/27	30/6/0	①②③④⑤	8
	cTACE	37			33/4	13/18/6	5.6±1.5	5/32	30/7/0
Li 2019^[17]	CSM-TACE	42	2015— 2017	回顾性	37/5	5/22/15	7.8±3.2	11/31	36/6/0	①②	7
	cTACE	39			33/6	8/22/9	6.7±4.0	6/33	34/5/0
Duan 2020^[18]	CSM-TACE	38	2017— 2018	回顾性	37/1	0/20/18	9.4±4.3	20/18	25/13/0	①②③④⑤⑥	9
	cTACE	48			46/2	0/25/23	9.9±4.2	27/21	35/13/0
Liang 2020^[19]	CSM-TACE	171	2014— 2017	回顾性	145/26	36/73/62	7.9±1.8	53/118	136/34/1	①②③④⑤	8
	cTACE	164			146/18	40/73/51	6.5±1.1	38/126	133/29/2
周素军2019^[20]	CSM-TACE	34	2016—2017	回顾性	30/4	0/19/15	7.5±1.19	NA	18/16/0	⑥⑦⑧	8
	cTACE	30			27/3	0/17/13	7.43±1.08	NA	16/14/0
王忠2019^[21]	CSM-TACE	45	2016—2017	回顾性	21/24	NA	5.43±1.68	NA	28/17/0	①③④⑤	7
	cTACE	45			23/22		5.46±1.74		26/19/0
蒲长宇2020^[22]	CSM-TACE	60	2016—2018	回顾性	44/16	0/48/12	5.42±2.36	NA	34/26/0	①③④⑤	7
	cTACE	60			46/14	0/45/15	5.32±1.81		36/24/0
刘娟芳2019^[23]	CSM-TACE	31	2016—2017	回顾性	NA	NA	NA	NA	NA	①	7
	cTACE	40
李富永2020^[24]	CSM-TACE	38	2016—2018	回顾性	29/9	NA	4.7±1.2	NA	17/21/0	①	7
	cTACE	38			25/13		5.1±1.2		12/26/0
陈刚2017^[25]	CSM-TACE	22	2015—2016	回顾性	19/3	5/9/8	NA	7/15	15/7/0	③④⑤	7
	cTACE	20			17/3	2/12/6		5/15	17/3/0
注: PVTT, 门静脉癌栓; ①总生存率; ②无进展生存率; ③发热率; ④腹痛; ⑤呕吐; ⑥腹水; ⑦骨髓抑制; ⑧粒细胞减少。

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