微波消融与手术切除在潜在可切除的结直肠癌肝转移中的临床效果Meta分析

doi:10.19401/j.cnki.1007-3639.2025.10.009

摘要/Abstract

摘要：

结直肠癌是全球癌症死亡的第三大原因，肝切除术是治疗结直肠癌肝转移的标准方法，微波消融作为微创治疗手段，为这些患者提供了新的治疗选择，而肝切除术和微波消融治疗结直肠癌肝转移患者的临床疗效优劣尚无定论。本研究检索了包括SinoMed、PubMed、Web of Science、EMBASE、中国知网、万方等多个数据库关于肝切除术与微波消融治疗结直肠癌肝转移的对照研究，检索截至2024年9月。本研究共纳入13篇文献，包括2 057例患者。使用纽卡斯尔-渥太华量表和Jadad量表评估所纳入的文献质量，论文研究质量均较高。提取了患者术后并发症、住院时间、手术时间、住院费用以及患者总生存（overall survival，OS）率和无病生存（disease-free survival，DFS）率的数据。使用Review Manager 5.4软件进行meta分析。研究结果显示微波消融组和手术切除组患者在OS（HR=1.03；95% CI: 0.85~1.25；P=0.77）和DFS（HR=1.27；95%CI: 0.94~1.71；P=0.13）方面差异无统计学意义。在肝转移个数≤5个和肝转移瘤大小≤3 cm的亚组分析中，微波消融组与手术切除组患者在OS和DFS方面差异无统计学意义（P<0.05）。微波消融组的住院时间、住院费用、手术时间和术中出血量均少于肝切除术组，且并发症发生率更低。因此对与肝转移个数≤5个和肝转移瘤大小≤3 cm的结直肠癌肝转移患者，微波消融是手术切除的有效替代方案，具有更低的治疗相关发病率。需要更多的随机对照试验和队列研究来进一步验证这些发现。本Meta分析在PROSPERO平台注册号为CRD42024610278。

关键词: 结直肠癌肝转移, 肝切除术, 微波消融, 患者生存, 术后并发症, Meta分析

Abstract:

Colorectal cancer is the third leading cause of cancer-related mortality worldwide. Hepatic resection is the standard treatment for colorectal cancer liver metastasis. Microwave ablation (MWA), as a minimally invasive therapeutic approach, offers an alternative treatment option for these patients. But the clinical efficacy of hepatic resection and MWA in treating colorectal cancer liver metastasis patients is still inconclusive. Literatures were retrieved on comparative studies about the treatment of colorectal cancer liver metastasis with hepatic resection and MWA from multiple databases, including sinoMed, PubMed, Web of Science, EMBASE, CNKI, Wanfang, etc. The cutoff date of retrieval was September 2024. Finally, a total of 13 studies comprising 2 057 patients, were included in this study. The papers were assessed using the Newcastle-Ottawa Scale and Jadad Scale. All included studies were of high quality. Data extraction focused on postoperative complications, length of hospital stay, surgical duration, hospitalization costs, and patient survival outcomes, including overall survival (OS) and disease-free survival (DFS). A meta-analysis was performed using Review Manager 5.4 software. There were no significant differences in OS (HR=1.03, 95% CI: 0.85-1.25, P=0.77) and DFS (HR=1.27, 95% CI: 0.94-1.71, P=0.13) between the MWA group and the hepatic resection group. In the subgroup analysis of patients with ≤5 liver metastases and size of metastases ≤3 cm, there were no statistically significant differences in OS and DFS between the MWA group and the hepatic resection group. The MWA group exhibited shorter hospital stay, reduced hospitalization costs, decreased surgical duration, less intraoperative blood loss, and lower incidence of complications compared to the hepatic resection group (P<0.05). Therefore, for patients with colorectal liver metastases characterized by a number of liver metastases ≤5 and size of metastases ≤3 cm, MWA serves as an effective alternative to hepatic resection, with a lower morbidity associated with treatment. Further validation of these findings is warranted through additional randomized controlled trials and cohort studies. The registration number of this Meta-analysis on the PROSPERO platform is CRD42024610278.

Key words: Colorectal cancer liver metastasis, Hepatic resection, Microwave ablation, Patient survival, Postoperative complications, Meta-analysis

中图分类号:

R735.3

孟泽松, 李保坤, 曹龙飞, 张建锋, 王贵英. 微波消融与手术切除在潜在可切除的结直肠癌肝转移中的临床效果Meta分析[J]. 中国癌症杂志, 2025, 35(10): 959-967.

MENG Zesong, LI Baokun, CAO Longfei, ZHANG Jianfeng, WANG Guiying. Microwave ablation versus hepatic resection in potentially resectable colorectal liver metastasis: a systematic review and meta-analysis[J]. China Oncology, 2025, 35(10): 959-967.

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