索拉菲尼对原发性肝癌术后患者疗效的系统评价

目的:系统评价索拉菲尼对原发性肝癌切除术后患者的疗效。方法:在Medline、Embase、Cochrane Library、中国知网（CNKI）数据库、万方数据库、中国生物医学数据库（CBM）检索有关索拉菲尼对原发性肝癌患者术后辅助治疗效果，主要观察目标为总生存期，次要观察目标为肿瘤复发率和死亡率。结果:索拉非尼治疗组与对照组比较，总生存率无显着性差异（HR=1.39，95％CI:0.71~2.74，P=0.34）；复发率无显著性差异（RR=0.81，95％CI:0.65~1.01，P=0.06）。随即我们根据文献类型，将研究分为试验性研究和观察性研究两个亚组来分析患者死亡率，发现临床试验组中肝癌术后接受索拉菲尼治疗的患者死亡率虽然降低但无统计学意义（P=0.45），而在观察研究组中是具有统计学意义的（RR=0.66，95％CI:0.51~0.87，P=0.003）。结论:对于肝癌术后患者索拉菲尼并不能提高患者总生存期，也不能降低肿瘤复发率，但亚组分析中可以降低患者的死亡率。因此索拉非尼是否是原发性肝癌切除后患者有效的辅助治疗手段，目前仍缺乏足够证据。

Efficacy of sorafenib in patients with hepatocellular carcinoma after resection:A Meta-analysis

Objective:To assess efficacy of sorafenib as adjuvant therapy for patients with hepatocellular carcinoma after resection.Methods:A systematic search was conducted of Medline，Embase，Cochrane Library，China National Knowledgeand the Internet Chinese Wanfang database，Chinese biological and medical database，search for efficacy of sorafenib as adjuvant therapy for patients with hepatocellular carcinoma after resection.The primary outcome was overall survival.Secondary outcomes included recurrence rate and mortality rate.Results:In the comparison of sorafenib versus control，no significant difference in overall survival(HR=1.39，95%CI:0.71~2.74，P=0.34) or recurrence rate［risk ratio(RR)=0.81，95%CI:0.65~1.01，P=0.06) was found.We use subgroups to analyze mortality,subgroup analysis was conducted according to study type,the RR was significantly reduced(RR=0.66, 95%CI:0.51~0.87,P=0.003) in observation study. Conclusion:In this Meta-analysis，sorafenib achieves no significant benefit in any of the endpoints except a lower mortality rate in subgroup analysis，indicating that there is no convincing evidence of sorafenib as an effective adjuvant therapy in patients with hepatocellular carcinoma after resection.