Objectives:The aim of this study was to compare the efficacy and safety of thermal ablation, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA), for hepatocellular carcinoma (HCC) using US-, CT-, and MR-guidance.Methods:PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies comparing US, CT, and MR guidance in thermal ablation for HCC. Observational studies and randomized controlled trials (RCTs) were included. Overall survival (OS), local tumor recurrence (LTR), primary technique effectiveness (PTE), and major complications were assessed with network meta-analysis.Results:One RCT and 13 retrospective cohort studies reporting on 2349 patients were included. For OS at 3 years, compared to CT, US had hazard ratios (HRs) of 0.98 (95%CI: 0.77–1.26), and MR had HRs of 1.60 (95%CI: 0.51–5.00); For OS at 5 years, US had HRs of 0.80 (95%CI: 0.64–1.01), and MR had HRs of 1.23 (95%CI: 0.52–2.95) compared to CT. LTR rates, PTE, and major complications did not show statistical significance among the three guidance modalities (LTR: RR = 0.29 (95%CI: 0.08–1.14),p= 0.97 MR vs. CT; RR = 0.25 (95%CI: 0.06–1.02),p= 0.97 MR vs. US; PTE: RR = 1.06 (95%CI: 0.96–1.17),p= 0.90 MR vs. CT; RR = 1.08 (95%CI: 0.98–1.20),p= 0.90 MR vs. US. Major complications: RR = 0.27 (95%CI: 0.13–0.59),p= 0.94 MR vs. CT; RR = 0.41 (95%CI: 0.10–1.74),p= 0.94 MR vs. US).Conclusions:CT-, US-, and MR-guided RFA and MWA are equally effective and safe for HCC patients.
目的：本研究旨在比较超声（US）、计算机断层扫描（CT）及磁共振（MR）引导下热消融技术（聚焦于射频消融[RFA]与微波消融[MWA]）治疗肝细胞癌（HCC）的疗效与安全性。 方法：系统检索PubMed、EMBASE、Cochrane Library及Web of Science数据库中比较US、CT与MR引导热消融治疗HCC的研究。纳入观察性研究及随机对照试验（RCT）。通过网状荟萃分析评估总生存期（OS）、局部肿瘤复发率（LTR）、初始技术有效率（PTE）及主要并发症。 结果：共纳入1项RCT及13项回顾性队列研究，涉及2349例患者。3年OS分析显示，与CT引导相比，US引导的风险比（HR）为0.98（95%CI：0.77–1.26），MR引导的HR为1.60（95%CI：0.51–5.00）；5年OS分析中，US引导的HR为0.80（95%CI：0.64–1.01），MR引导的HR为1.23（95%CI：0.52–2.95）。三种引导方式在LTR、PTE及主要并发症方面均无统计学显著差异（LTR：MR对比CT的RR=0.29[95%CI：0.08–1.14]，p=0.97；MR对比US的RR=0.25[95%CI：0.06–1.02]，p=0.97。PTE：MR对比CT的RR=1.06[95%CI：0.96–1.17]，p=0.90；MR对比US的RR=1.08[95%CI：0.98–1.20]，p=0.90。主要并发症：MR对比CT的RR=0.27[95%CI：0.13–0.59]，p=0.94；MR对比US的RR=0.41[95%CI：0.10–1.74]，p=0.94）。 结论：CT、US及MR引导的RFA与MWA对HCC患者具有同等的疗效与安全性。
肿瘤(癌症)患者之家