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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

彭一晟, 何攀, 朱刚, 等. 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[J]. 临床肝胆病杂志, 2021, 37(8): 1841-1847. DOI: 10.3969/j.issn.1001-5256.2021.08.019
引用本文: 彭一晟, 何攀, 朱刚, 等. 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[J]. 临床肝胆病杂志, 2021, 37(8): 1841-1847. DOI: 10.3969/j.issn.1001-5256.2021.08.019
PENG YS, HE P, ZHU G, et al. Efficacy and safety of CalliSpheres microsphere versus conventional transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma: A Meta-analysis [J]. J Clin Hepatol, 2021, 37(8): 1841-1847. DOI: 10.3969/j.issn.1001-5256.2021.08.019
Citation: PENG YS, HE P, ZHU G, et al. Efficacy and safety of CalliSpheres microsphere versus conventional transcatheter arterial chemoembolization in treatment of hepatocellular carcinoma: A Meta-analysis [J]. J Clin Hepatol, 2021, 37(8): 1841-1847. 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
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

详细信息
    通讯作者:

    杨小李, 344920646@qq.com

  • 中图分类号: R735.7

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

Funds: 

National Natural Science Foundation of China 81802778

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

  • 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。

     

  • 图  1  文献检索流程图

    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。

    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。

    图  4  2组术后发热率的Meta分析

    图  5  2组术后腹痛率的Meta分析

    图  6  2组术后呕吐率的Meta分析

    图  7  2组术后腹水率的Meta分析

    图  8  2组术后骨髓抑制的Meta分析

    图  9  2组术后粒细胞减少的Meta分析

    图  10  发表偏倚分析

    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 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 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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