射频消融与手术治疗结直肠癌肝转移疗效的Meta分析
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摘要
目的比较射频消融(RFA)与肝脏切除术(HR)在结直肠癌肝转移(CRLM)患者治疗中的作用。方法系统检索Cochrane library、Pub Med、荷兰医学文摘(EMbase)、中国知网、万方数据库、维普数据库从建库至2018年5月关于比较RFA和HR治疗CRLM患者的临床对照研究,并对所有的纳入研究进行质量评价,采用Cochrane library提供的软件Rev Man 5.3进行分析。结果最后纳入文献26篇,共包括3738例患者,其中RFA组1447例,HR组2291例。Meta分析结果显示:RFA组5年总生存率、5年无病生存率明显低于HR组(OR=2.42,95%CI:1.64～3.57,P <0.000 01;OR=2.33,95%CI:1.37～3.98,P=0.002);RFA组局部复发率、肝内复发率明显高于HR组(OR=9.29,95%CI:6.88～12.54,P <0.000 01;OR=2.03,95%CI:1.45～2.83,P <0.0001);RFA组术后总并发症发生率低于HR组(OR=0.47,95%CI:0.29～0.76,P=0.002)。结论 RFA并发症发生率明显低于HR,但生存率较低,复发率较高。HR仍是CRLM首选的治疗方式。
Objective To compare the therapeutic efficacy between radiofrequency ablation(RFA) and hepatic resection(HR) for colorectal liver metastases(CRLM). Methods Systematic literature search of clinical trials was carried out to compare RFA and HR for colorectal liver metastasis in Cochrane library, PubMed, Embase, CNKI, Wanfang and VIP from database inception to May 2018. The quality of the included studies was assessed and the data analysis was performed by software RevMan 5.3 from Cochrane library. Results Finally 26 trials including 3738 cases were included,with 1447 cases in RFA group and 2291 cases in HR group. The results of Meta-analysis showed: 5-year overall survival and 5-year disease-free survival were significantly lower in RFA group than HR group(OR = 2.42, 95% CI:1.64-3.57, P < 0.000 01; OR = 2.33, 95% CI: 1.37-3.98, P = 0.002). Local recurrence and intrahepatic recurrence rates were significantly higher in RFA group than HR group(OR = 9.29, 95%CI: 6.88-12.54, P < 0.000 01; OR = 2.03,95%CI: 1.45-2.83, P < 0.0001). RFA had significantly lower postoperative complication rate than HR group(OR =0.47, 95%CI: 0.29-0.76, P = 0.002). Conclusion The complication rate in patients treated by RFA is significantly lower than HR, but survival rate is lower and recurrence rate is higher by RFA than HR. HR is still the preferred treatment for CRLM.
Objective To compare the therapeutic efficacy between radiofrequency ablation(RFA) and hepatic resection(HR) for colorectal liver metastases(CRLM). Methods Systematic literature search of clinical trials was carried out to compare RFA and HR for colorectal liver metastasis in Cochrane library, PubMed, Embase, CNKI, Wanfang and VIP from database inception to May 2018. The quality of the included studies was assessed and the data analysis was performed by software RevMan 5.3 from Cochrane library. Results Finally 26 trials including 3738 cases were included,with 1447 cases in RFA group and 2291 cases in HR group. The results of Meta-analysis showed: 5-year overall survival and 5-year disease-free survival were significantly lower in RFA group than HR group(OR = 2.42, 95% CI:1.64-3.57, P < 0.000 01; OR = 2.33, 95% CI: 1.37-3.98, P = 0.002). Local recurrence and intrahepatic recurrence rates were significantly higher in RFA group than HR group(OR = 9.29, 95%CI: 6.88-12.54, P < 0.000 01; OR = 2.03,95%CI: 1.45-2.83, P < 0.0001). RFA had significantly lower postoperative complication rate than HR group(OR =0.47, 95%CI: 0.29-0.76, P = 0.002). Conclusion The complication rate in patients treated by RFA is significantly lower than HR, but survival rate is lower and recurrence rate is higher by RFA than HR. HR is still the preferred treatment for CRLM.
引文
[1]李道娟,李倩,贺宇彤.结直肠癌流行病学趋势[J].肿瘤防治研究,2015,42(3):305-310.
[2]蔡建强,蔡三军,秦新裕,等.结直肠癌肝转移诊断和综合治疗指南(2016)[J].中国实用外科杂志,2016,36(8):858-869.
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[5]Kageyama K,Yamamoto A,Okuma T,et al.Radiofrequency ablation of liver tumors in combination with local OK-432 injection prolongs survival and suppresses distant tumor growth in the rabbit model with intra-and extrahepatic VX2 tumors[J].Cardiovasc Interv Radiol,2013,36(5):1383-1392.
[6]Abdalla EK,Vauthey JN,Ellis LM,et al.Recurrence and outcomes following hepatic resection,radiofrequency ablation,and combined resection/ablation for colorectal liver metastases[J].Ann Surg,2004,239(6):818-825.
[7]Agcaoglu O,Aliyev S,Karabulut K,et al.Complementary use of resection and radiofrequency ablation for the treatment of colorectal liver metastases:an analysis of 395 patients[J].World J Surg,2013,37(6):1333-1339.
[8]Aliyev S,Agcaoglu O,Aksoy E,et al.Efficacy of laparoscopic radiofrequency ablation for the treatment of patients with small solitary colorectal liver metastasis[J].Surgery,2013,154(3):556-562.
[9]Aloia TA,Vauthey JN,Loyer EM,et al.Solitary colorectal liver metastasis:resection determines outcome[J].Arch Surg,2006,141(5):460-466.
[10]Berber E,Tsinberg M,Tellioglu G,et al.Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis[J].J Gastrointest Surg Off J Soc Surg Aliment Tract,2008,12(11):1967-1972.
[11]Curley SA.Outcomes after surgical treatment of colorectal cancer liver metastases[J].Semin Oncol,2005,32(9):109-111.
[12]Gleisner AL,Choti MA,Assumpcao L,et al.Colorectal liver metastases:recurrence and survival following hepatic resection,radiofrequency ablation,and combined resection-radiofrequency ablation[J].Arch Surg,2008,143(12):1204-1212.
[13]He N,Jin QN,Wang D,et al.Radiofrequency Ablation vs.Hepatic Resection for Resectable Colorectal Liver Metastases[J].J Huazhong Univ Sci Technolog Med Sci,2016,36(4):514-518.
[14]Hur H,Ko YT,Min BS,et al.Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases[J].Am J Surg,2009,197(6):728-736.
[15]Jasarovic D,Stojanovic D,Mitrovic N,et al.Resection or radiofrequency ablation of colorectal liver metastasis[J].Vojnosanitet Pregled Mil Med Pharm Rev,2014,71(6):542-546.
[16]Kim KH,Yoon YS,Yu CS,et al.Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases[J].J Korean Surg Soc,2011,81(1):25-34.
[17]Ko S,Jo H,Yun S,et al.Comparative analysis of radiofrequency ablation and resection for resectable colorectal liver metastases[J].World J Gastroenterol,2014,20(2):525-531.
[18]Lee WS,Yun SH,Chun HK,et al.Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis[J].J Clin Gastroenterol,2008,42(8):945-949.
[19]Lee KH,Kim HO,Yoo CH,et al.Comparison of radiofrequency ablation and resection for hepatic metastasis from colorectal cancer[J].Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi,2012,59(3):218-223.
[20]Lee BC,Lee HG,Park IJ,et al.The role of radiofrequency ablation for treatment of metachronous isolated hepatic metastasis from colorectal cancer[J].Medicine,2016,95(39):e4999.
[21]Mc Kay A,Fradette K,Lipschitz J.Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases[J].HPB Surg,2009,2009:346 863.
[22]Oshowo A,Gillams A,Harrison E,et al.Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases[J].Br J Surg,2003,90(10):1240-1243.
[23]Otto G,Duber C,Hoppe-Lotichius M,et al.Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery[J]Ann Surg,2010,251(5):796-803.
[24]Park IJ,Kim HC,Yu CS,et al.Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery[J].Ann Surg Oncol,2008,15(1):227-232.
[25]Reuter NP,Woodall CE,Scoggins CR,et al.Radiofrequency ablation vs.resection for hepatic colorectal metastasis:therapeutically equivalent[J].J Gastrointest Surg,2009,13(3):486-491.
[26]White RR,Avital I,Sofocleous CT,et al.Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis[J].J Gastrointest Surg Off J Soc Surg Aliment Tract,2007,11(3):256-263.
[27]刘旭忠,韩松.射频消融和手术切除对孤立性结直肠癌肝转移患者生活质量及疗效的改善作用[J].国际医药卫生导报,2016,22(15):2291-2293.
[28]卢欣,李孝成,吴永融.手术切除与射频消融治疗结直肠癌肝转移的对比研究[J].实用临床医药杂志,2015,19(15):62-64.
[29]周雪玲,何晓兰,蔡蕾,等.结直肠癌肝转移射频消融与手术切除疗效比较[J].中华肝脏外科手术学电子杂志,2017,6(3):212-215.
[30]聂勇,杨绥冲,常浩生,等.射频消融与手术治疗结直肠癌肝转移疗效比较[J].肝胆胰外科杂志,2013,25(4):313-315.
[31]邵子力,吴健,陈敏山,等.射频消融与手术切除治疗结直肠癌肝转移的疗效比较[J].广东医学,2012,33(10):1410-1413.
[32]Le Golvan MP,Resnick M.Pathobiology of colorectal cancer hepatic metastases with an emphasis on prognostic factors[J].J Surg Oncol,2010,102(8):898-908.
[33]Berber E,Siperstein A.Local recurrence after laparoscopic radiofrequency ablation of liver tumors:an analysis of 1032 tumors[J].Ann Surg Oncol,2008,15(10):2757-2764.
[2]蔡建强,蔡三军,秦新裕,等.结直肠癌肝转移诊断和综合治疗指南(2016)[J].中国实用外科杂志,2016,36(8):858-869.
[3]van der Geest LG,Lam-Boer J,Koopman M,et al.Nationwide trends in incidence,treatment and survival of colorectal cancer patients with synchronous metastases[J]Clin Exp Metastasis,2015,32(5):457-465.
[4]Clancy C,Burke JP,Barry M,et al.A meta-analysis to determine the effect of primary tumor resection for stageⅣcolorectal cancer with unresectable metastases on patient survival[J].Ann Surg Oncol,2014,21(12):3900-3908.
[5]Kageyama K,Yamamoto A,Okuma T,et al.Radiofrequency ablation of liver tumors in combination with local OK-432 injection prolongs survival and suppresses distant tumor growth in the rabbit model with intra-and extrahepatic VX2 tumors[J].Cardiovasc Interv Radiol,2013,36(5):1383-1392.
[6]Abdalla EK,Vauthey JN,Ellis LM,et al.Recurrence and outcomes following hepatic resection,radiofrequency ablation,and combined resection/ablation for colorectal liver metastases[J].Ann Surg,2004,239(6):818-825.
[7]Agcaoglu O,Aliyev S,Karabulut K,et al.Complementary use of resection and radiofrequency ablation for the treatment of colorectal liver metastases:an analysis of 395 patients[J].World J Surg,2013,37(6):1333-1339.
[8]Aliyev S,Agcaoglu O,Aksoy E,et al.Efficacy of laparoscopic radiofrequency ablation for the treatment of patients with small solitary colorectal liver metastasis[J].Surgery,2013,154(3):556-562.
[9]Aloia TA,Vauthey JN,Loyer EM,et al.Solitary colorectal liver metastasis:resection determines outcome[J].Arch Surg,2006,141(5):460-466.
[10]Berber E,Tsinberg M,Tellioglu G,et al.Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis[J].J Gastrointest Surg Off J Soc Surg Aliment Tract,2008,12(11):1967-1972.
[11]Curley SA.Outcomes after surgical treatment of colorectal cancer liver metastases[J].Semin Oncol,2005,32(9):109-111.
[12]Gleisner AL,Choti MA,Assumpcao L,et al.Colorectal liver metastases:recurrence and survival following hepatic resection,radiofrequency ablation,and combined resection-radiofrequency ablation[J].Arch Surg,2008,143(12):1204-1212.
[13]He N,Jin QN,Wang D,et al.Radiofrequency Ablation vs.Hepatic Resection for Resectable Colorectal Liver Metastases[J].J Huazhong Univ Sci Technolog Med Sci,2016,36(4):514-518.
[14]Hur H,Ko YT,Min BS,et al.Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases[J].Am J Surg,2009,197(6):728-736.
[15]Jasarovic D,Stojanovic D,Mitrovic N,et al.Resection or radiofrequency ablation of colorectal liver metastasis[J].Vojnosanitet Pregled Mil Med Pharm Rev,2014,71(6):542-546.
[16]Kim KH,Yoon YS,Yu CS,et al.Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases[J].J Korean Surg Soc,2011,81(1):25-34.
[17]Ko S,Jo H,Yun S,et al.Comparative analysis of radiofrequency ablation and resection for resectable colorectal liver metastases[J].World J Gastroenterol,2014,20(2):525-531.
[18]Lee WS,Yun SH,Chun HK,et al.Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis[J].J Clin Gastroenterol,2008,42(8):945-949.
[19]Lee KH,Kim HO,Yoo CH,et al.Comparison of radiofrequency ablation and resection for hepatic metastasis from colorectal cancer[J].Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi,2012,59(3):218-223.
[20]Lee BC,Lee HG,Park IJ,et al.The role of radiofrequency ablation for treatment of metachronous isolated hepatic metastasis from colorectal cancer[J].Medicine,2016,95(39):e4999.
[21]Mc Kay A,Fradette K,Lipschitz J.Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases[J].HPB Surg,2009,2009:346 863.
[22]Oshowo A,Gillams A,Harrison E,et al.Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases[J].Br J Surg,2003,90(10):1240-1243.
[23]Otto G,Duber C,Hoppe-Lotichius M,et al.Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery[J]Ann Surg,2010,251(5):796-803.
[24]Park IJ,Kim HC,Yu CS,et al.Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery[J].Ann Surg Oncol,2008,15(1):227-232.
[25]Reuter NP,Woodall CE,Scoggins CR,et al.Radiofrequency ablation vs.resection for hepatic colorectal metastasis:therapeutically equivalent[J].J Gastrointest Surg,2009,13(3):486-491.
[26]White RR,Avital I,Sofocleous CT,et al.Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis[J].J Gastrointest Surg Off J Soc Surg Aliment Tract,2007,11(3):256-263.
[27]刘旭忠,韩松.射频消融和手术切除对孤立性结直肠癌肝转移患者生活质量及疗效的改善作用[J].国际医药卫生导报,2016,22(15):2291-2293.
[28]卢欣,李孝成,吴永融.手术切除与射频消融治疗结直肠癌肝转移的对比研究[J].实用临床医药杂志,2015,19(15):62-64.
[29]周雪玲,何晓兰,蔡蕾,等.结直肠癌肝转移射频消融与手术切除疗效比较[J].中华肝脏外科手术学电子杂志,2017,6(3):212-215.
[30]聂勇,杨绥冲,常浩生,等.射频消融与手术治疗结直肠癌肝转移疗效比较[J].肝胆胰外科杂志,2013,25(4):313-315.
[31]邵子力,吴健,陈敏山,等.射频消融与手术切除治疗结直肠癌肝转移的疗效比较[J].广东医学,2012,33(10):1410-1413.
[32]Le Golvan MP,Resnick M.Pathobiology of colorectal cancer hepatic metastases with an emphasis on prognostic factors[J].J Surg Oncol,2010,102(8):898-908.
[33]Berber E,Siperstein A.Local recurrence after laparoscopic radiofrequency ablation of liver tumors:an analysis of 1032 tumors[J].Ann Surg Oncol,2008,15(10):2757-2764.