全球肿瘤介入治疗的研究现状_《中国循证医学杂志》

作者：

王应强 ¹ , 李向莲 ¹ ,  李幼平 ¹ , 邓绍林 ² , 罗倩倩 ³ , 韦诗友 ²

1. 四川大学华西医院中国循证医学中心（成都 610041）；2. 四川大学华西临床医学院（成都 610041）；3. 国家（成都）中药安全性评价中心（成都 610041）;

关键词：

肿瘤介入治疗系统评价文献计量学分析

DOI：

10.7507/1672-2531.20130183

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　循证评价全球肿瘤介入治疗的发展趋势、优势病种及其临床效果，为介入技术的规范准入提供参考依据。
方法　计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI和VIP 等数据库，全面收集肿瘤介入治疗的临床或基础研究，检索时限均为建库至2012年9月。由两位研究者按照纳入与排除标准独立筛选文献、提取资料，再用SPSS 13.0和Excel 2003软件进行描述性分析。
结果　共纳入4 544个研究，其中临床研究4 136个（91.0%），基础研究408个（9.0%）。4 136个临床研究中包括155个系统评价/Meta分析（SR/Meta分析），338个随机对照试验（RCT），1 191个临床对照试验（CCT），2 451个病例系列/病例报告（CS/CR）。临床肿瘤介入技术以肝动脉插管化疗栓塞（TACE，32.6%）和射频消融术（RFA，17.1%）居多；优势病种为肝细胞癌（HCC）［包括99篇（57.6%）SR/Meta分析、198篇（58.6%）RCT，824篇（69.1%）CCT，1 191篇（48.6%）CS/CR］，其次是结直肠癌肝转移（CLM）。与经皮乙醇注射（PEI）相比，分别有12个和10个SR/Meta分析结果显示RFA治疗HCC的3年生存率更高和复发率更低。与肝切除术（HR）相比，分别有11个和9个SR/Meta分析结果显示RFA的3年和5年生存率更低，但17个SR/Meta分析结果显示两组在1年生存率方面无差异。分别有6个和3个SR/Meta分析结果表明，肝切除术或肝移植术前行TACE并不能提高中晚期HCC患者的生存期，但术后行TACE能提高患者1年和3年生存率。TACE联合其他介入技术（RFA、PEI）亦能显著提高HCC患者的生存时间。对子宫肌瘤治疗，有证据显示：与手术相比，子宫动脉栓塞（UAE）的住院或手术时间更短，但再干预率更高，且目前缺乏长期临床结局的证据。
结论　肿瘤介入治疗是一种可供肿瘤患者选择和临床应用前景广泛的治疗手段。但临床使用时需全方位考虑当前可得的最佳临床证据，结合医疗设备及技术水平的实际情况，科学、合理、规范地实施相关介入技术。

引用本文： 王应强,李向莲,李幼平,邓绍林,罗倩倩,韦诗友. 全球肿瘤介入治疗的研究现状. 中国循证医学杂志, 2013, 13(9): 1060-1072. doi: 10.7507/1672-2531.20130183 复制

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1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 2010, 127(12): 2893-2917.
2. Soerjomataram I, Lortet-Tieulent J, Parkin DM, et al. Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions. Lancet, 2012, 380(9856): 1840-1850.
3. Kimman M, Norman R, Jan S, et al. The burden of cancer in member countries of the Association of Southeast Asian Nations (ASEAN). Asian Pac J Cancer Prev, 2012, 13(2): 411-420.
4. Bray F, Jemal A, Grey N, et al. Global cancer transitions according to the Human Development Index (2008-2030): a population-based study. Lancet Oncol, 2012, 13(8): 790-801.
5. Gupta JK, Sinha A, Lumsden MA, et al. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2006, (1): CD005073.
6. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
7. van der Kooij SM, Bipat S, Hehenkamp WJ, et al. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol, 2011, 205(4): 317 e1-18.
8. Sud S, Maheshwari A, Bhattacharya S. Obstetric outcomes after treatment of fibroids by uterine artery embolization: a systematic review (Provisional abstract). Expert Rev of Obstet Gynecol, 2009: 429-441.
9. Buyse M. Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst, 1996, 88(5): 252-258.
10. Harmantas A, Rotstein LE, Langer B. Regional versus systemic chemotherapy in the treatment of colorectal carcinoma metastatic to the liver. Is there a survival difference? Meta-analysis of the published literature. Cancer, 1996, 78(8): 1639-1645.
11. Mocellin S, Pasquali S, Nitti D. Fluoropyrimidine-HAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2009, (3): CD007823.
12. Mathurin P, Raynard B, Dharancy S, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther, 2003, 17(10): 1247-1261.
13. Marelli L, Stigliano R, Triantos C, et al. Treatment outcomes for hepatocellular carcinoma using chemoembolization in combination with other therapies. Cancer Treat Rev, 2006, 32(8): 594-606.
14. Samuel M, Chow PKH, Shih-Yen EC, et al. Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev, 2009, (1): CD001199.
15. Chua TC, Liauw W, Saxena A, et al. Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma. Liver Int, 2010, 30(2): 166-174.
16. Wang X, Li J, Peng Y, et al. Influence of preoperative transarterial chemoembolization on the prognosis for patients with resectable hepatocellular carcinoma: a meta-analysis of randomized trials. Hepatogastroenterology, 2011, 58(107-108): 869-874.
17. Zhong JH, Li LQ. Postoperative adjuvant transarterial chemoembolization for participants with hepatocellular carcinoma: A meta-analysis. Hepatol Res, 2010, 40(10): 943-953.
18. 马良, 钟鉴宏, 黎乐群, 等. 肝动脉化疗栓塞在肝细胞性肝癌切除术后应用的系统评价. 中国癌症防治杂志, 2011, 3(1): 74-81.
19. 顾国文, 李相成. 肝癌切除术后经肝动脉化疗栓塞对预防复发和提高生存率疗效的系统评价. 南京医科大学学报·自然科学版, 2008, 28(6): 726-732.
20. Oliveri Roberto S, Wetterslev J, Gluud C. Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2011.
21. Meng MB, Cui YL, Lu Y, et al. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol, 2009, 92(2): 184-194.
22. Gu GW, Li XC. [Meta-analysis of the efficacy of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer][Article in Chinese]. Chinese Medical Journal, 2009, 89(12): 805-809.
23. Wang W, Shi J, Xie WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int, 2010, 30(5): 741-749.
24. Wang N, Guan QL, Wang K, et al. TACE combined with PEI versus TACE alone in the treatment of HCC: a meta-analysis. Med Oncol, 2011, 28(4): 1038-1043.
25. 孙贤俊, 何胜利, 沈婕, 等. 射频消融联合经动脉化疗栓塞治疗肝癌的疗效分析. 中国临床医学, 2011, 18(6): 803-808.
26. Xie F, Zang J, Guo X, et al. Comparison of transcatheter arterial chemoembolization and microsphere embolization for treatment of unresectable hepatocellular carcinoma: a meta-analysis. J cancer res clin oncol, 2012, 138(2): 455-462.
27. Meng MB, Cui YL, Guan YS, et al. Traditional Chinese medicine plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma. J Altern Complement Med, 2008, 14(8): 1027-1042.
28. Sun QZ, Ma WL, Gao Y, et al. Meta-Analysis: Therapeutic Effect of Transcatheter Arterial Chemoembolization Combined with Compound Kushen Injection in Hepatocellular Carcinoma. Afr J Tradit Complement Alt M, 2012, 9(2): 178-188.
29. Cho W, Chen H. Investigation of the efficacy on transcatheter arterial chemoembolization combined with or without Chinese herbal therapy for hepatocellular carcinoma: Meta-analysis. Eur J Cancer, Supplement, 2009, 7(2-3): 393-394.
30. Martin R, Geller D, Espat J, et al. Safety and efficacy of trans arterial chemoembolization with drug-eluting beads in hepatocellular cancer: a systematic review. Hepatogastroenterology, 2012, 59(113): 255-260.
31. He J, Xie F, Yang J, et al. Transarterial chemoembolization for palliation of unresectable liver metastases from colorectal cancer (Protocol for a systematic review) (Structured abstract). Health Technol Assess, 2010. p. Crd32010000481.
32. Llovet JM, Lencioni R, Di Bisceglie AM, et al. EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol, 2012, 56(4): 908-943.
33. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology, 2011, 53(3): 1020-1022.
34. Galandi D, Antes G. Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2004, (2): CD003046.
35. Lopez PM, Villanueva A, Llovet JM. Systematic review: evidence-based management of hepatocellular carcinoma - an updated analysis of randomized controlled trials. Aliment Pharmacol Ther, 2006, 23(11): 1535-1547.
36. 周泉波, 卢桠楠, 陈汝福, 等. 射频消融与经皮无水乙醇注射治疗小肝癌临床效果比较的系统评价. 中华肝胆外科杂志, 2011, 17(3): 189-193.
37. Zhou YM, Zhao YF, Li B, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol, 2010, 10: 78.
38. Liu JG, Wang YJ, Du Z. Radiofrequency ablation in the treatment of small hepatocellular carcinoma: a meta analysis. World J Gastroenterol, 2010, 16(27): 3450-3456.
39. Liu Z, Zhou Y, Zhang P, et al. Meta-analysis of the therapeutic effect of hepatectomy versus radiofrequency ablation for the treatment of hepatocellular carcinoma (Structured abstract). Surg Laparosc Endosc and Percutan Tech, 2010, 20(3): 130-140.
40. Li L, Zhang JL, Liu XH, et al. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: A meta-analysis. Journal of Gastroenterology and Hepatology, 2012, 27(1): 51-58.
41. Gravante G, Overton J, Sorge R, et al. Radiofrequency ablation versus resection for liver tumours: an evidence-based approach to retrospective comparative studies. J Gastrointest Surg, 2011, 15(2): 378-387.
42. Sutherland LM, Williams JA, Padbury RT, et al. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg, 2006, 141(2): 181-190.
43. Stang A, Fischbach R, Teichmann W, et al. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer, 2009, 45(10): 1748-1756.
44. Wu YZ, Li B, Wang T, et al. Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis: a meta-analysis. World J Gastroenterol, 2011, 17(36): 4143-4148.
45. Khajanchee YS, Hammill CW, Cassera MA, et al. Hepatic resection vs minimally invasive radiofrequency ablation for the treatment of colorectal liver metastases: a Markov analysis. Arch Surg, 2011, 146(12): 1416-1423.
46. Bipat S, van Leeuwen MS, Ijzermans JNM, et al. Evidence-based guideline on management of colorectal liver metastases in the Netherlands. Neth J Med, 2007, 65(1): 5-14.
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《中国循证医学杂志》

全球肿瘤介入治疗的研究现状

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《中国循证医学杂志》

全球肿瘤介入治疗的研究现状

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