全球腫瘤介入治療的研究現狀_《中國循證醫學雜志》

作者：

王應強 ¹ , 李向蓮 ¹ ,  李幼平 ¹ , 鄧紹林 ² , 羅倩倩 ³ , 韋詩友 ²

1. 四川大學華西醫院中國循證醫學中心（成都 610041）；2. 四川大學華西臨床醫學院（成都 610041）；3. 國家（成都）中藥安全性評價中心（成都 610041）;

關鍵詞：

腫瘤介入治療系統評價文獻計量學分析

DOI：

10.7507/1672-2531.20130183

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　循證評價全球腫瘤介入治療的發展趨勢、優勢病種及其臨床效果，為介入技術的規范準入提供參考依據。
方法　計算機檢索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI和VIP 等數據庫，全面收集腫瘤介入治療的臨床或基礎研究，檢索時限均為建庫至2012年9月。由兩位研究者按照納入與排除標準獨立篩選文獻、提取資料，再用SPSS 13.0和Excel 2003軟件進行描述性分析。
結果　共納入4 544個研究，其中臨床研究4 136個（91.0%），基礎研究408個（9.0%）。4 136個臨床研究中包括155個系統評價/Meta分析（SR/Meta分析），338個隨機對照試驗（RCT），1 191個臨床對照試驗（CCT），2 451個病例系列/病例報告（CS/CR）。臨床腫瘤介入技術以肝動脈插管化療栓塞（TACE，32.6%）和射頻消融術（RFA，17.1%）居多；優勢病種為肝細胞癌（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］，其次是結直腸癌肝轉移（CLM）。與經皮乙醇注射（PEI）相比，分別有12個和10個SR/Meta分析結果顯示RFA治療HCC的3年生存率更高和復發率更低。與肝切除術（HR）相比，分別有11個和9個SR/Meta分析結果顯示RFA的3年和5年生存率更低，但17個SR/Meta分析結果顯示兩組在1年生存率方面無差異。分別有6個和3個SR/Meta分析結果表明，肝切除術或肝移植術前行TACE并不能提高中晚期HCC患者的生存期，但術后行TACE能提高患者1年和3年生存率。TACE聯合其他介入技術（RFA、PEI）亦能顯著提高HCC患者的生存時間。對子宮肌瘤治療，有證據顯示：與手術相比，子宮動脈栓塞（UAE）的住院或手術時間更短，但再干預率更高，且目前缺乏長期臨床結局的證據。
結論　腫瘤介入治療是一種可供腫瘤患者選擇和臨床應用前景廣泛的治療手段。但臨床使用時需全方位考慮當前可得的最佳臨床證據，結合醫療設備及技術水平的實際情況，科學、合理、規范地實施相關介入技術。

引用本文： 王應強,李向蓮,李幼平,鄧紹林,羅倩倩,韋詩友. 全球腫瘤介入治療的研究現狀. 中國循證醫學雜志, 2013, 13(9): 1060-1072. doi: 10.7507/1672-2531.20130183 復制

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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. 馬良, 鐘鑒宏, 黎樂群, 等. 肝動脈化療栓塞在肝細胞性肝癌切除術后應用的系統評價. 中國癌癥防治雜志, 2011, 3(1): 74-81.
19. 顧國文, 李相成. 肝癌切除術后經肝動脈化療栓塞對預防復發和提高生存率療效的系統評價. 南京醫科大學學報·自然科學版, 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. 孫賢俊, 何勝利, 沈婕, 等. 射頻消融聯合經動脈化療栓塞治療肝癌的療效分析. 中國臨床醫學, 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.
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36. 周泉波, 盧椏楠, 陳汝福, 等. 射頻消融與經皮無水乙醇注射治療小肝癌臨床效果比較的系統評價. 中華肝膽外科雜志, 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.
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《中國循證醫學雜志》

全球腫瘤介入治療的研究現狀

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