单纯肝动脉栓塞化疗或联合无水酒精注射治疗肝细胞癌疗效比较的Meta分析

目的评价肝动脉栓塞化疗（TACE）联合无水乙醇注射治疗肝细胞癌的疗效和安全性。方法检索PubMed、Cochrane图书馆、Embase、中国生物医学数据库和万方数据库至2012年12月的最新数据，收集所有TACE联合无水乙醇注射与单纯TACE治疗肝细胞癌患者的随机对照研究（RCT）。按照纳入和排除标准选择文献、提取资料和评价纳入研究的方法学质量后，采用RevMan 5.1进行Meta分析。结果在13个RCT共962例患者，显示TACE联合无水乙醇注射治疗1年、2年和3年生存率均较单纯TACE更优，其OR值分别为3.78（95%CI为2.79-5.12）、3.07（95%CI为2.27-4.17）和5.84（95%CI为2.86-11.93）；在其中6个RCT共294例患者，联合治疗患者血清甲胎蛋白下降至正常者显著优于单纯TACE治疗组（OR=4.0，95%CI为2.24-7.15），但两组间AFP下降（≥25%）而未达正常者无明显差异（OR=1.24，95%CI为0.68-2.27）；两组均未出现严重的不良反应。结论 TACE联合无水乙醇注射治疗患者生存率及AFP下降至正常均优于单纯TACE治疗，患者的生存率明显提高，无严重的不良反应。

Transcatheter arterial chem oembolization combined with percutaneous ethanol injection in the treat-ment of patients with hepatocellular carcinoma:a Meta analysis

Objective To assess the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with percutaneous ethanol injection （PEI） versus TACE alone in the treatment of patients with hepato-cellular carcinoma （HCC）. Methods A systematic search of literatures in PubMed,the Cochrane Library,Em-base, Chinese Biomedicine Literature Database,Wan Fang Database since database establishment to December, 2012 was performed;All randomized controlled trials （RCTs） on TACE combined with PEI versus TACE alone were collected;The literatures were screened according to inclusive and exclusive criteria,and data were extracted and the quality of included studies were assessed;A Meta-analysis was conducted by using RevMan 5.1. Results A total of 13 RCTs with 962 patients was included and the results showed that the 1-,2- and 3-year survival rates of TACE combined with PEI were better than that of TACE alone,with the OR-value of 3.78 （95%CI=2.79 to 5.12）,3.07 （95%CI=2.27 to 4.17） and 5.84 （95%CI=2.86 to 11.93）,respectively;A total of 6 RCTs with 294 patients out of 14 papers showed that the combination therapy was better than TACE alone （OR=4.0,95%CI=2.24 to 7.15）in the rate of AFP normalization,but the reduction of≥25%（not to normal） in AFP was not significant （OR=1.24,95%CI=0.68 to 2.27）;Both Combination therapy and TACE alone did not show serious adverse reac-tions. Conclusion The survival and AFP normalization rate in TACE combine with PEI is better than TACE alone, and there is no increased serious adverse reaction following the improved survival rate.