经皮无水酒精治疗直径≤3cm肝癌的系统评价

目的系统评价经皮无水酒精（PEI）治疗直径≤3cm肝癌的疗效和安全性。方法计算机检索Cochrane图书馆临床对照试验数据库（2008年第2期）、PubMed（1978～2008）、EMbase（1966—2008）、Ovid（2000-2008）、中国生物医学文献数据库（1978-2008）和中国期刊全文数据库（1979～2008），手工检索中、英文已发表和未发表的资料以及查阅文后参考文献，文献检索无语种限制。按Cochrane系统评价方法筛选试验、评价纳入研究的方法学质量、提取资料，并用RevMan4．2．10版软件进行Meta分析。结果本系统评价纳共入7个随机对照试验，包括891例患者。按测量指标和干预措施进行亚组分析。结果显示，直径≤3cm肝癌治疗后1、3年生存率与局部复发率，PEI与经皮射频消融（RFA）治疗比较差异均有统计学意义RR=0．95，95％CI（0．91，1．00）；RR=0．80，95％CI（0．71，0．91）；RR=2，18，95％CI（1．11，4．30）；RR=2．59，95％CI（1．55，4．32）]；PEI与经RFA治疗比较，直径2-3cm的肝癌治疗后3年无瘤生存率差异有统计学意义RR=0．47，95％CI（0．24，0．93）]；两种治疗方式在其余指标方面的差异均无统计学意义。结论现有有限证据表明，对于直径≤3cm的肝癌，PEI与经皮醋酸注射（PAl）治疗、手术切除的疗效相当；PEI注射十RFA与RFA治疗的疗效无差异；治疗直径≤2cm肝癌，PEI的疗效与RFA无差别，但RFA治疗直径2～3cm肝癌的疗效优于PEI。由于本系统评价纳入RCT数量及样本量较少，质量偏低，一些主要测量指标报道过少，缺乏足够信息进行分析，尚需开展更多更高质量RCT进一步验证其疗效和安全性。

Percutaneous Ethanol Injection to Treat Hepatocellular Carcinoma of 3 cm or Less: A Systematic Review

Objective To evaluate the efficacy and safety of percutaneous ethanol injection for hepatocellular carcinomas of 3 cm or less. Methods Randomized controlled trials （RCTs） from the Cochrane Controlled Trials Register （Cochrane Library issue 2, 2008）, PubMed （1966 to 2008）, EMbase （1966 to 2008）, CBMdisc （1978 to 2008）, and CNKI （1979 to 2008） were electronically searched. We hand searched related published and unpublished data and their references. Randomized controlled trials of percutaneous ethanol injection to treat hepatocellular carcinomas of 3 cm or less were included. Data were extracted and evaluated by two reviewers independently using a designed extraction form. RevMan 4.2.10 software was used for data analysis. Results Seven RCTs involving 891 patients were included. We conducted subgroup analyses based on outcome measures and interventions. Compared with RFA, for treatment of hepatocellular carcinomas of 3 cm or less, PEI showed statistical differences in one and three-year survival rates and one and three-year local recurrence rates after treatment（RR=0.95, 95%CI 0.91 to 1.00; RR=0.80, 95%CI 0.71 to 0.91; RR=2.18, 95%CI 1.11 to 4.30; RR=2.59, 95%CI 1.55 to 4.32）. As for hepatocellular carcinomas of 2-3 cm, PEI showed statistical difference in three year cancer free survival rates after treatment（RR=0.47, 95%CI 0.24 to 0.93） .Conclusion Considering the relatively poor quality of most included trials and small sample size, insufficient evidence was obtained in this systematic review. Therefore, more randomized controlled trials with high quality are still needed to assess and verify the efficacy and safety of this treatment.