Radiofrequency Ablation versus Resection for Colorectal Cancer Liver Metastases A Meta-Analysis 英文参考文献.docVIP

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Radiofrequency Ablation versus Resection for Colorectal Cancer Liver Metastases A Meta-Analysis 英文参考文献.doc

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Radiofrequency Ablation versus Resection for Colorectal Cancer Liver Metastases A Meta-Analysis 英文参考文献

RadiofrequencyAblationversusResectionforColorectal CancerLiverMetastases:AMeta-Analysis MingzheWeng.,YongZhang.,DiZhou,YongYang,ZhaohuiTang,MingningZhao,ZhiweiQuan*, WeiGong* DepartmentofGeneralSurgery,XinhuaHospital,SchoolofMedicine,ShanghaiJiaotongUniversity,Shanghai,China Abstract Background: No randomized controlled trial (RCT) has yet been performed to provide the evidence to clarify the therapeuticdebateonliverresection(LR)andradiofrequencyablation(RFA)intreatingcolorectallivermetastases(CLM). Themeta-analysiswasperformedtosummarizetheevidencemostlyfromretrospectiveclinicaltrialsandtoinvestigatethe effectofLRandRFA. Methodology/PrincipalFindings:SystematicliteraturesearchofclinicalstudieswascarriedouttocompareRFAandLRfor CLMinPubmed,EmbaseandtheCochraneLibraryCentraldatabases.Themeta-analysiswasperformedusingriskratio(RR) andrandomeffectmodel,inwhich95%confidenceintervals(95%CI)forRRwerecalculated.Primaryoutcomeswerethe overallsurvival(OS)anddisease-freesurvival(DFS)at3and5yearsplusmortalityandmorbidity.1prospectivestudyand12 retrospectivestudieswerefinallyeligibleformeta-analysis.LRwassignificantlysuperiortoRFAin3-yearOS(RR1.377,95% CI:1.246–1.522);5-yearOS(RR:1.474,95%CI:1.284–1.692);3-yearDFS(RR1.735,95%CI:1.483–2.029)and5-yearDFS(RR 2.227,95%CI:1.823–2.720).ThepostoperativemorbiditywashigherinLR(RR:2.495,95%CI:1.881–3.308),butnosignificant differencewasfoundinmortalitybetweenLRandRFA.Thedatafromthe3subgroups(tumor,3cm;solitarytumor;open surgeryorlaparoscopicapproach)showedsignificantlybetterOSandDFSinpatientswhoreceivedsurgicalresection. Conclusions/Significances:Althoughmultipleconfoundersexistintheclinicaltrialsespeciallythebiasinpatientselection, LRwassignificantlysuperiortoRFAinthetreatmentofCLM,evenwhenconditionslimitedtotumor,3cm,solitarytumor andopensurgeryorlaparoscopic(lap)approach.Therefore,cautionshouldbetakenwhentreatingCLMwithRFAbefore moresupportiveevidencesforRFAfromRCTsareobtained. Citation: WengM,ZhangY,ZhouD,YangY,TangZ,etal.(2012)Radio