载药微球与传统碘化油经肝动脉化疗栓塞术治疗不可切除肝癌效果比较的Meta分析
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摘要
目的系统评价载药微球经肝动脉化疗栓塞术(DEB-TACE)与常规经导管动脉化疗栓塞术(cTACE)经导管动脉化疗栓塞治疗不可切除肝癌的疗效。方法检索PubMed、Embase、Cochrane library和CNKI数据库中有关DEB-TACE与cTACE治疗不可切除肝癌的临床对照试验的文献。根据纳入和排除标准筛选文献,筛选出有效数据后,采用Revman 5. 3软件进行Meta分析,比较两者完全缓解(CR)率、部分缓解(PR)率、术后疾病稳定(SD)率、6个月和12个月生存率。结果共纳入12篇文献,共1177例患者,519例患者接受DEB-TACE治疗,658例接受cTACE治疗。与cTACE组相比,DEB-TACE组CR率显著增加[相对风险度(RR)=1. 42; 95%可信区间(95%CI):1. 18～1. 72,P=0. 0002],术后12个月生存率显著增加(RR=1. 09; 95%CI:1. 01～1. 17,P=0. 03)。两组PR率(RR=1. 13; 95%CI:0. 97～1. 30,P=0. 12)、SD率(RR=0. 82; 95%CI:0. 64～1. 05,P=0. 12)、6个月生存率(RR=1. 05; 95%CI:1. 00～1. 10,P=0. 07)无显著性差异。结论与碘化油TACE相比,载药微球更具疗效优势的趋势。
Objective To systematically review the clinical effect of transcatheter arterial chemoembolization with drug-eluting beads(DEB-TACE) versus conventional transcatheter arterial chemoembolization(cTACE) in the treatment of unresectable liver cancer. Methods PubMed,Embase,Cochrane,and CNKI were searched for articles on clinical control trials of DEB-TACE versus cTACE in the treatment of unresectable liver cancer. The articles were screened according to inclusion and exclusion criteria,and after valid data were extracted,Revman 5. 3 software was used for meta-analysis. The two groups were compared in terms of the number of patients with complete remission(CR),partial remission(PR),or stable disease(SD) and 6-and 12-month survival rates. Results A total of 12 articles were included,with 1177 patients in total,among whom 519 patients underwent DEB-TACE and 658 underwent cTACE. Compared with the cTACE group,the DEB-TACE group had a significantly higher number of patients with CR(risk ratio [RR]= 1. 42,95% confidence interval [CI]: 1. 18-1. 72,P = 0. 0002),and had a significantly higher 12-month survival rate(RR = 1. 09,95% CI: 1. 01-1. 17,P =0. 03). There were no significant differences between the two groups in the number of patients with PR(RR = 1. 13,95% CI: 0. 97-1. 30,P = 0. 12),the number of patients with SD(RR = 0. 82,95% CI: 0. 64-1. 05,P = 0. 12),6-month survival rate(RR = 1. 05,95% CI: 1. 00-1. 10,P = 0. 07). Conclusion DEB-TACE has a better therapeutic effect than cTACE with iodinated oil.
Objective To systematically review the clinical effect of transcatheter arterial chemoembolization with drug-eluting beads(DEB-TACE) versus conventional transcatheter arterial chemoembolization(cTACE) in the treatment of unresectable liver cancer. Methods PubMed,Embase,Cochrane,and CNKI were searched for articles on clinical control trials of DEB-TACE versus cTACE in the treatment of unresectable liver cancer. The articles were screened according to inclusion and exclusion criteria,and after valid data were extracted,Revman 5. 3 software was used for meta-analysis. The two groups were compared in terms of the number of patients with complete remission(CR),partial remission(PR),or stable disease(SD) and 6-and 12-month survival rates. Results A total of 12 articles were included,with 1177 patients in total,among whom 519 patients underwent DEB-TACE and 658 underwent cTACE. Compared with the cTACE group,the DEB-TACE group had a significantly higher number of patients with CR(risk ratio [RR]= 1. 42,95% confidence interval [CI]: 1. 18-1. 72,P = 0. 0002),and had a significantly higher 12-month survival rate(RR = 1. 09,95% CI: 1. 01-1. 17,P =0. 03). There were no significant differences between the two groups in the number of patients with PR(RR = 1. 13,95% CI: 0. 97-1. 30,P = 0. 12),the number of patients with SD(RR = 0. 82,95% CI: 0. 64-1. 05,P = 0. 12),6-month survival rate(RR = 1. 05,95% CI: 1. 00-1. 10,P = 0. 07). Conclusion DEB-TACE has a better therapeutic effect than cTACE with iodinated oil.
引文
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[6]MALAGARI K,POMONI M,MOSCHOURIS H,et al.Chemoembolization withdoxorubicin-eluting beads for unresectable hepatocellular car-cinoma:Five-year survival analysis[J].Cardiovasc Intervent Radiol,2012,35(5):1119-1128.
[7]CHEN QW,YING HF,GAO S,et al.Radiofrequency ablation plus chemoembolization versusradiofrequency ablation alone for hepatocellular carcinoma:A systematic review and metaanalysis[J].Clin Res Hepatol Gastroenterol,2016,40(3):309-314.
[8]GEEST LG,MEER S,SCHRIER,et al.Survival in relation to hospitaltype after resection or sorafenib treatment for hepatocellularcarcinoma in the Netherlands[J].Clin Res Hepatol Gastroenterol,2015,39(6):725-735.
[9]MARTIN R,GELLER D,ESPAT J,et al.Safety and efficacy of trans arterial chemoembolizationwith drug-eluting beads in hepatocellular cancer:A systematicreview[J].Hepatogastroenterology,2012,59(113):255-260.
[10]CHEN G,ZHANG D,YING YC,et al.Clinical investigation on transarterial chemoembolization with indigenous drug-eluting beads in treatment of unresectable hepatocellular carcinoma[J].J Zhejiang Univ:Med Sci,2017,46(1):44-51.(in Chinese)陈刚,张鼎,应亚草,等.国产载药微球经动脉化疗栓塞治疗不可切除原发性肝癌的临床研究[J].浙江大学学报:医学版,2017,46(1):44-51.
[11]CHI Q,ZHANG LL,LIU B,et al.Efficacy of epirubicin combined with lipiodol or Hepasphere loaded microspheres in the treatment of TACE in patients with hepatocellular carcinoma[J].Mod Oncol,2018,26(13):2090-2093.(in Chinese)池琦,张玲玲,刘彬,等.表柔比星分别联合碘油与Hepasphere载药微球对肝癌患者TACE的疗效分析[J].现代肿瘤医学,2018,26(13):2090-2093.
[12]FERRER P,PARRA C,ESTEBAN E,et al.Comparison of doxorubicin-eluting bead transarterial chemoembolization(DEB-TA-CE)with conventional transarterial chemoembolization(TACE)for the treatment of hepatocellular carcinoma[J].Radiologia,2011,53(3):246-253.
[13]HUANG YJ,LING YZ,QIN ZL,et al.Evaluation of the effect of HepaSphere transmitted microspheres in the treatment of primary liver cancer[J].Clin Med,2018,38(1):35-36.(in Chinese)黄英杰,凌永志,秦梓良,等.HepaSphere载药微球治疗原发性肝癌的效果评价[J].临床医学,2018,38(1):35-36.
[14]LAMMER J,MALAGARI K,VOGL T,et al.Prospective randomized study of Doxorubicin-Eluting-Bead embolization in the treatment of hepatocellular carcinoma:Results of the PRE-CISION V study[J].Cardiovasc Intervent Radiol,2010,33(1):41-52.
[15]LENCIONI R,MALAGARI K,VOGL T,et al.A randomized phase II trial of a drug eluting bead in the treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization[J].Hepatology,2009,20(2):s70-s71.
[16]MALAGRI K,POMONI M,KELEKIS A,et al.Prospective randomized comparison of chemoembolization with doxorubicineluting beads and bland embolization with BeadBlock for hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2010,33(3):541-551.
[17]SACCO R,BARGELLINI I,BERTIN M,et al.Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma[J].J Vasc Interv Radiol,2011,22(11):1545-1552.
[18]SONG MJ,CHUN HJ,SONG DS,et al.Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma[J].J Hepatol,2012,57(6):1244-1250.
[19]WIGGERMANN P,SIERON D,BROSCHE C,et al.Transarterial chemoembolization of Child-A hepatocellular carcinoma:Drug-eluting bead TACE(DEB TACE)vs.TACE with Cisplatin/Lipiodol(cTACE)[J].Med Sci Monit,2011,17(4):189-195.
[20]YOU JX,WANG JB,AI ST,et al.TACE by using microspheres and lipiodol for the treatment of hepatocellular carcinoma:Analysis of short-term efficacy[J].J Intervent Radiol,2017,26(6):531-534.(in Chinese)游建雄,王精兵,艾松涛,等.微球联合碘油栓塞治疗肝癌的近期疗效分析[J].介入放射学杂志,2017,26(6):531-534.
[21]DHANASEKARAN K,KOOBY DA,STALEY CA,et al.Comparison of conventional transarterial chemoembolization(TA-CE)and chemoembolization with doxorubicin drug eluting beads(DEB)for unresectable hepatocelluar carcinoma(HCC)[J].J Surg Onc,2010,101(6):476-480.
[22]GOLFIERI R,GIAMPALMA E,RENZULLI M,et al.Randomised controlled trial ofdoxorubicin-eluting beads vs conventional chemoembolisationfor hepatocellular carcinoma[J].Br J Cancer,2014,111(2):255-264.
[23]MEMON K,KULIK L,LEWANDOWSKI RJ,et al.Radiographic response to locoregional therapy in hepatocellular carcinoma predicts patient survival times[J].Gastroenterology,2011,141(2):526-535,e522.
[24]OU SQ,CHEN ZY,MA YL,et al.Meta-analysis of comparative study between doxoruibcin-eluting beads and conventional transarterial hemoeobolization for hepatocellular carcinoma[J].Chin J Interv Imaging Ther,2011,11(11):712-716.(in Chinese)欧盛秋,陈祖毅,马亦龙,等.阿霉素载药微球与传统的碘化油经导管动脉化疗栓塞术治疗原发性肝癌疗效的Meta分析[J].中国介入影像与治疗学,2011,11(11):712-716.
[25]MALAGARI K,ALEXOPOULOU E,CHATZIMICHAIL K,et al.Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments:Midterm results of doxorubicin-loaded DC bead[J].Abdom Imaging,2008,33(5):512-519.
[26]QI XS,ZHAO Y,LI HY,et al.Management of hepatocellular carcinoma:an overview of major findings from meta-analyses[J].Oncotarget,2016,7(23):34703-34751.
[27]GAO S,YANG Z,ZHENG Z,et al.Doxorubicin-eluting bead versus conventional TACE for unresectable hepatocellular carcinoma:A meta analysis[J].Hepatogastroenterology,2013,60(126):813-820.
[28]HAN SL,ZHANG XP,ZOU LL,et al.Does drug-eluting bead transcatheter arterial chemoembolization improve the management of patients with hepatocellular carcinoma?A Meta-Analysis[J].PLo S One,2014,9(8):e1022686.
[29]HUANG K,ZHOU,WANG R,et al.Doxorubicin-elutingbeads versus conventional transarterial chemoembolization forthe treatment of hepatocellular carcinoma[J].J Gastroenterol Hepatol,2014,29(5):920-925.
[30]CHEN P,YUAN P,CHEN B,et al.Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma:A systematic review and meta-analysis[J].Clin Res Hepatol Gastroenterol,2017,41(1):75-85.
[2]WU J,YIN F,LUO GH,et al.Clinical effect and safety of transarterial chemoembolization combined with apatinib in treatment of advanced primary liver cancer[J].J Clin Hepatol,2018,34(4):775-778.(in Chinese)武健,尹芳,罗贯虹,等.经肝动脉化疗栓塞术联合阿帕替尼治疗中晚期原发性肝癌的效果及安全性分析[J].临床肝胆病杂志,2018,34(4):775-778.
[3]TALAL A,AHMED M,ADB E,et al.Intra-arterial chemoembolization with hepasphere 50-100μm for patients with unresectable hepatocellular carcinoma:Initial experience in Egyptian Liver Hospital[J].Egypt J Radiol Nucl Med,2015,46(5):957-965.
[4]FORNER A,GILABERT M,BRUIX J,et al.Treatment of intermediate-stage hepatocellular carcinoma[J].Nat Rev Clin Oncol,2014,11(9):525-535.
[5]TERZI E,GOLFIERI R,PISCAGLIA F,et al.Response rate and clinical outcome of HCC afterfirst and repeated cTACEperformed“on demand”[J].J Hepatol,2012,57(6):1258-1267.
[6]MALAGARI K,POMONI M,MOSCHOURIS H,et al.Chemoembolization withdoxorubicin-eluting beads for unresectable hepatocellular car-cinoma:Five-year survival analysis[J].Cardiovasc Intervent Radiol,2012,35(5):1119-1128.
[7]CHEN QW,YING HF,GAO S,et al.Radiofrequency ablation plus chemoembolization versusradiofrequency ablation alone for hepatocellular carcinoma:A systematic review and metaanalysis[J].Clin Res Hepatol Gastroenterol,2016,40(3):309-314.
[8]GEEST LG,MEER S,SCHRIER,et al.Survival in relation to hospitaltype after resection or sorafenib treatment for hepatocellularcarcinoma in the Netherlands[J].Clin Res Hepatol Gastroenterol,2015,39(6):725-735.
[9]MARTIN R,GELLER D,ESPAT J,et al.Safety and efficacy of trans arterial chemoembolizationwith drug-eluting beads in hepatocellular cancer:A systematicreview[J].Hepatogastroenterology,2012,59(113):255-260.
[10]CHEN G,ZHANG D,YING YC,et al.Clinical investigation on transarterial chemoembolization with indigenous drug-eluting beads in treatment of unresectable hepatocellular carcinoma[J].J Zhejiang Univ:Med Sci,2017,46(1):44-51.(in Chinese)陈刚,张鼎,应亚草,等.国产载药微球经动脉化疗栓塞治疗不可切除原发性肝癌的临床研究[J].浙江大学学报:医学版,2017,46(1):44-51.
[11]CHI Q,ZHANG LL,LIU B,et al.Efficacy of epirubicin combined with lipiodol or Hepasphere loaded microspheres in the treatment of TACE in patients with hepatocellular carcinoma[J].Mod Oncol,2018,26(13):2090-2093.(in Chinese)池琦,张玲玲,刘彬,等.表柔比星分别联合碘油与Hepasphere载药微球对肝癌患者TACE的疗效分析[J].现代肿瘤医学,2018,26(13):2090-2093.
[12]FERRER P,PARRA C,ESTEBAN E,et al.Comparison of doxorubicin-eluting bead transarterial chemoembolization(DEB-TA-CE)with conventional transarterial chemoembolization(TACE)for the treatment of hepatocellular carcinoma[J].Radiologia,2011,53(3):246-253.
[13]HUANG YJ,LING YZ,QIN ZL,et al.Evaluation of the effect of HepaSphere transmitted microspheres in the treatment of primary liver cancer[J].Clin Med,2018,38(1):35-36.(in Chinese)黄英杰,凌永志,秦梓良,等.HepaSphere载药微球治疗原发性肝癌的效果评价[J].临床医学,2018,38(1):35-36.
[14]LAMMER J,MALAGARI K,VOGL T,et al.Prospective randomized study of Doxorubicin-Eluting-Bead embolization in the treatment of hepatocellular carcinoma:Results of the PRE-CISION V study[J].Cardiovasc Intervent Radiol,2010,33(1):41-52.
[15]LENCIONI R,MALAGARI K,VOGL T,et al.A randomized phase II trial of a drug eluting bead in the treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization[J].Hepatology,2009,20(2):s70-s71.
[16]MALAGRI K,POMONI M,KELEKIS A,et al.Prospective randomized comparison of chemoembolization with doxorubicineluting beads and bland embolization with BeadBlock for hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2010,33(3):541-551.
[17]SACCO R,BARGELLINI I,BERTIN M,et al.Conventional versus doxorubicin-eluting bead transarterial chemoembolization for hepatocellular carcinoma[J].J Vasc Interv Radiol,2011,22(11):1545-1552.
[18]SONG MJ,CHUN HJ,SONG DS,et al.Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma[J].J Hepatol,2012,57(6):1244-1250.
[19]WIGGERMANN P,SIERON D,BROSCHE C,et al.Transarterial chemoembolization of Child-A hepatocellular carcinoma:Drug-eluting bead TACE(DEB TACE)vs.TACE with Cisplatin/Lipiodol(cTACE)[J].Med Sci Monit,2011,17(4):189-195.
[20]YOU JX,WANG JB,AI ST,et al.TACE by using microspheres and lipiodol for the treatment of hepatocellular carcinoma:Analysis of short-term efficacy[J].J Intervent Radiol,2017,26(6):531-534.(in Chinese)游建雄,王精兵,艾松涛,等.微球联合碘油栓塞治疗肝癌的近期疗效分析[J].介入放射学杂志,2017,26(6):531-534.
[21]DHANASEKARAN K,KOOBY DA,STALEY CA,et al.Comparison of conventional transarterial chemoembolization(TA-CE)and chemoembolization with doxorubicin drug eluting beads(DEB)for unresectable hepatocelluar carcinoma(HCC)[J].J Surg Onc,2010,101(6):476-480.
[22]GOLFIERI R,GIAMPALMA E,RENZULLI M,et al.Randomised controlled trial ofdoxorubicin-eluting beads vs conventional chemoembolisationfor hepatocellular carcinoma[J].Br J Cancer,2014,111(2):255-264.
[23]MEMON K,KULIK L,LEWANDOWSKI RJ,et al.Radiographic response to locoregional therapy in hepatocellular carcinoma predicts patient survival times[J].Gastroenterology,2011,141(2):526-535,e522.
[24]OU SQ,CHEN ZY,MA YL,et al.Meta-analysis of comparative study between doxoruibcin-eluting beads and conventional transarterial hemoeobolization for hepatocellular carcinoma[J].Chin J Interv Imaging Ther,2011,11(11):712-716.(in Chinese)欧盛秋,陈祖毅,马亦龙,等.阿霉素载药微球与传统的碘化油经导管动脉化疗栓塞术治疗原发性肝癌疗效的Meta分析[J].中国介入影像与治疗学,2011,11(11):712-716.
[25]MALAGARI K,ALEXOPOULOU E,CHATZIMICHAIL K,et al.Transcatheter chemoembolization in the treatment of HCC in patients not eligible for curative treatments:Midterm results of doxorubicin-loaded DC bead[J].Abdom Imaging,2008,33(5):512-519.
[26]QI XS,ZHAO Y,LI HY,et al.Management of hepatocellular carcinoma:an overview of major findings from meta-analyses[J].Oncotarget,2016,7(23):34703-34751.
[27]GAO S,YANG Z,ZHENG Z,et al.Doxorubicin-eluting bead versus conventional TACE for unresectable hepatocellular carcinoma:A meta analysis[J].Hepatogastroenterology,2013,60(126):813-820.
[28]HAN SL,ZHANG XP,ZOU LL,et al.Does drug-eluting bead transcatheter arterial chemoembolization improve the management of patients with hepatocellular carcinoma?A Meta-Analysis[J].PLo S One,2014,9(8):e1022686.
[29]HUANG K,ZHOU,WANG R,et al.Doxorubicin-elutingbeads versus conventional transarterial chemoembolization forthe treatment of hepatocellular carcinoma[J].J Gastroenterol Hepatol,2014,29(5):920-925.
[30]CHEN P,YUAN P,CHEN B,et al.Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma:A systematic review and meta-analysis[J].Clin Res Hepatol Gastroenterol,2017,41(1):75-85.
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