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TACE联合索拉非尼治疗不可切除肝细胞癌疗效及安全性系统评价再评价

Reevaluation of Systematic Evaluation of the Efficacy and Safety of Transcatheter Arterial Chemoembolization Combined with Sorafenib in the Treatment of Unresectable Hepatocellular Carcinoma
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摘要 目的对目前发表的动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合索拉非尼治疗不可切除肝细胞癌(hepatocellular carcinoma,HCC)有效性和安全性的系统评价/Meta分析进行再评价。方法计算机检索PubMed、Embase、the Cochrane Library、CNKI和万方数据知识服务平台,收集TACE联合索拉非尼治疗HCC的系统评价/Meta分析,年限为建库至2022年8月。试验组患者给予TACE联合索拉非尼治疗,对照组患者给予其他常规治疗。筛选文献并提取数据,采用PRISMA评价纳入文献报告质量,AMSTAR 2量表评价纳入文献方法学质量,GRADE评价纳入文献结局指标和证据质量。结果共纳入9篇文献,包含43个结局指标。PRISMA评分为20.5~25.5分,高质量7篇,中等质量2篇。AMSTAR 2质量评价结果显示,所有文献均为极低质量,存在问题最多的关键条目是条目2和条目7。GRADE评价结果表明,高质量指标4项,中等质量指标15项,低质量指标21项以及无法评价指标3项,导致降级的最主要因素是偏倚风险,其次为不一致性。在疗效方面,与对照组比较,试验组患者的1年生存率、疾病进展时间、客观缓解率、疾病控制率明显提高。但在不良反应(腹泻、手足综合征、高血压)发生率方面,对照组显著优于试验组。结论TACE联合索拉非尼治疗HCC相关系统评价/Meta分析的方法学质量和证据质量较差,规范性仍需进一步提高。 Objective To conduct reevaluation of systematic review/Meta-analysis on the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with sorafenib in the treatment of unresectable hepatocellular carcinoma(HCC).Methods The systematic reviews and Meta-analysis of TACE combined with sorafenib in the treatment of HCC were collected through computer searches on PubMed,Embase,the CochraneLibrary,CNKI and Wanfang data knowledge service platform.The time limit was from database inception to August 2022.The experimental group received TACE combined with sorafenib,and the control group received other conventional treatments.After screening the literature and extracting the data,PRISMA statement was adopted to evaluate the quality of the included reports,AMSTAR 2scale was used for methodological quality evaluation,and GRADE tool was used for outcome indicator and evidence quality evaluation.Results A total of 9 literatures were included,including 43 outcome indicators.The PRISMA score was 20.5-25.5,including 7 articles of high quality and 2 articles of moderate quality.The results of AMSTAR 2 quality evaluation show that all the literatures were of extremely low quality,and the key items with the most problems were item 2 and item 7.The results of GRADE evaluation showed that there were 4 high quality indicators,15medium quality indicators,21 low quality indicators and 3 unevaluable indicators.The main factor leading to degradation was bias risk,followed by inconsistency.In terms of curative effect,compared with the control group,the 1-year survival rate,time to progression,objective response rate and disease control rate of patients in the experimental group were significantly improved.However,the incidence of adverse reactions(diarrhea,hand and foot syndrome,hypertension)in the control group was significantly better than those in the experimental group.Conclusion The methodology quality and evidence quality of systematic review/Meta-analysis related to TACE combined with sorafenib in the treatment of HCC is poor,and the standardization still needs to be further improved.
作者 梁昭君 赵宝银 张丽霞 王俊科 于晓辉 LIANG Zhaojun;ZHAO Baoyin;ZHANG Lixia(Department of Gastroenterology,The 940th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army,Gansu 730050,China)
出处 《医学研究杂志》 2023年第11期142-148,共7页 Journal of Medical Research
基金 甘肃省重点研发计划项目(20YF8FA099) 甘肃省临床医学研究中心建设项目(21JR7RA017)。
关键词 经动脉化疗栓塞 索拉非尼 肝细胞癌 系统评价再评价 Transcatheter arterial chemoembolization Sorafenib Hepatocellular carcinoma Reevaluation of systematic evaluation
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