无法切除的结直肠肝转移患者行放疗加化疗与单纯化疗的比较：Meta分析

Selective Internal Radiotherapy plus Chemotherapy versus Chemotherapy Alone in Patients with Unresectable Colorectal Liver Metastases: A Meta-Analysis

摘要: 目的：本研究旨在评估选择性内放疗加化疗对无法切除的结直肠肝转移患者的疗效。方法：检索Pubmed、CNKI、Embase、Cochrane图书馆中心等电子文献数据库中截至2021年7月发表的文章。以中文和英文撰写的文章均被考虑在内。只选择随机对照试验，通过缓解率、病情进展、无进展生存期和总生存期评价联合治疗的疗效。结果：本研究纳入4个随机对照试验，共报告1238名参与者，其中622名接受选择性内放疗加化疗，616名接受单纯化疗。结果显示，联合治疗的患者客观缓解率较高(RR = 2.04, 95% CI 1.02~4.09, P = 0.04)，进展期较低(RR = 0.36, 95% CI 0.16~0.82, P = 0.02)，无进展生存期(HR = 1.61, 95% CI 0.70~3.72, P = 0.27)和总生存期(HR = 1.22, 95% CI 0.84~1.10, P = 0.29)差异无统计学意义。结论：选择性内放疗对肝脏病灶的短期显著改善并不能转化为长期生存的益处。

Abstract: Objective: This meta-analysis was designed to assess the efficacy of selective internal radiotherapy plus chemotherapy in patients with unresectable colorectal liver metastases. Method: Electronic literature databases including Pubmed, CNKI, Embase and the Cochrane Library Center were searched for articles published till July 2021. The articles written in both Chinese and English were considered. Only randomized controlled trials were selected. Main outcomes (response rate, progressive disease, progression-free survival and overall survival) were evaluated by assessing the efficacy of the combined treatment. Results: Four randomized controlled trials were included in this meta-analysis and a total of 1238 participants were reported (622 treated with selective internal radiotherapy plus chemotherapy and 616 treated with chemotherapy alone). The results showed patients who were treated with combined treatment had higher objective response rate (RR = 2.04, 95% CI 1.02~4.09, P = 0.04), lower progressive disease (RR = 0.36, 95% CI 0.16~0.82, P = 0.02), no significant difference in progression-free survival (HR = 1.61, 95% CI 0.70~3.72, P = 0.27) and overall survival (HR = 1.22, 95% CI 0.84~1.10, P = 0.29). Conclusions: The significant improvement in liver disease control of the addition of selective internal radiotherapy did not translate to a benefit in survival.